Certified Professional Coder

Only applicants who reside in Oregon or Washington will be considered.

JOB SUMMARY

The Certified Professional Coder is responsible for ensuring accurate, timely, and compliant coding and charge capture of all assigned claims while ensuring compliance with ICD-10, CPT, and HCPCS guidelines. This position supports revenue cycle performance by reviewing charge sessions in Epic Charge Review, auditing auto-released claims, resolving coding-related denials and claim edits, and providing monthly education and performance feedback to assigned providers.

MAJOR RESPONSIBILITIES

• Coding Review-Review and resolve charge sessions routed to Epic Charge Review work queues., Validate CPT, HCPCS, ICD-10-CM, and modifier selection for accuracy and compliance. Ensure documentation supports all reported services. Correct coding discrepancies prior to claim submission. Maintain productivity standards while ensuring coding quality and compliance.
• Claim Quality Assurance-Audit auto-released professional claims for coding accuracy and payer-specific compliance. Identify trends resulting in coding errors or claim rejections. Recommend workflow improvements to reduce manual corrections and increase first-pass payment rates.
• Denial Management-Investigate and resolve coding-related claim denials and payer edits. Analyze denial trends involving Oregon Medicaid and commercial insurance plans. Submit corrected claims and coding revisions in accordance with payer guidelines. Collaborate with Revenue Cycle Billing and Clinical Operations to prevent recurring denials.
• Provider Education-Serve as the coding resource for assigned providers and care teams. Deliver individualized education regarding documentation, coding accuracy, modifier usage, and payer requirements. Develop educational materials based on audit findings and denial trends. Promote compliant documentation practices that improve clean claim performance.

JOB REQUIREMENTS

EDUCATION: Minimum- High School Diploma or equivalent and graduate of a Medical Coding Program

WORK EXPERIENCE: Minimum- Three (3) year of progressive coding experience. Preferred- Two (2) years of progressive coding experience in a pediatric care setting

CERTIFICATIONS: Certified Coding Associate (CCA), Certified Coding Specialist (CCS)

KNOWLEDGE, SKILLS, & ABILITIES:

• Knowledge of, but not limited to, current Official Coding Guidelines and methodologies, MS-DRG, APR-DRG, ICD-10-CM/PCS coding guidelines and conventions.
• Extensive knowledge of medical terminology, anatomy and pathophysiology, pharmacology, and ancillary test results
• Demonstrates critical thinking skills, and ability to interpret, assess, and evaluate provider documentation.
• Advanced knowledge of pediatric coding and documentation requirements.
• Knowledgeable in Epic Charge Review workflows.
• Proficient with Microsoft Office applications (Outlook, Word, Excel)

COMPETENCIES

• Accuracy – Creates a quality product with a high level of accuracy
• Communication –Engages in constructive interactions
• Computer Skills – Proficient ability to use a computer and electronic medical record.
• Confidentiality – Maintain patient, team member, and employer confidentiality.
• Customer Service Oriented – Friendly, enthusiastic, and helpful to others.
• Decision Making – Ability to make critical judgments while under pressure.
• Detail Oriented – Aptitude to pay attention to the specifics of a project or task.
• Flexibility – Capacity to adapt quickly to changing conditions and work responsibilities
• Positivity – Display an optimistic attitude and is a progressive agent for needed change.
• Teamwork – Demonstrates collaboration, values input and maintains effective working relationships.

WORK ENVIRONMENT

• High-volume pediatric ambulatory practice supporting approximately 7500-9500 professional visits per month with other coders.
• Primarily computer-based work utilizing Epic Professional Billing.
• Frequent collaboration with providers, clinical leadership, and Revenue Cycle teams.
• Remote work based on organizational policy.

Only applicants who reside in Oregon or Washington will be considered.

Immunizations are a requirement for employment to help ensure a safe and healthy workplace by reducing the risk of communicable diseases. TCC requires proof of vaccination including MMR, Hepatitis B, Tdap, Varicella, Influenza, and TB Screening.