Certified Coder
OSU Physicians, Inc. (Columbus, Ohio)

The Certified Coder monitors the coding and reimbursement activities for professional services provided to patients within a specified clinical area or group of clinical specialty areas. This position utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements. The Certified Coder will assign specified codes to medical diagnoses and/or clinical procedures. Willingness to adapt to an evolving job description and expand your responsibilities as the company grows. The Certified Coder performs within established OSUP standards, applying knowledge and understanding of the practice plan.

The Certified Coder monitors the coding and reimbursement activities for professional services provided to patients within a specified clinical area or group of clinical specialty areas. This position utilizes advanced knowledge of specialty coding to analyze patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements. The Certified Coder will assign specified codes to medical diagnoses and/or clinical procedures. Willingness to adapt to an evolving job description and expand your responsibilities as the company grows. The Certified Coder performs within established OSUP standards, applying knowledge and understanding of the practice plan.

• Determine accurate CPT, HCPCS procedure and professional supply codes and ICD-9-CM diagnosis codes used for billing services provided by physicians and licensed nonphysician

providers.

• Keep current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues.

• Perform various activities related to physician practice management and coding to maintain compliance with payer reimbursement policies and Federal health care program requirements.

• Providing training and education on coding and compliance issues to physicians, nonphysicianproviders and staff on an ongoing basis.

• Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation as well as communication on coding and compliance issues.

• Performs audits and analyses of payer denials; provides information on compliance issues arising from audits and formulates recommendations to providers regarding improved documentation practices to avoid future claims denials.

• Researches inquiries from providers and patients about fees, reimbursements, and denials.

• Monitors data sources to ensure receipt and analysis of all charges.

• Update encounter forms/super bills on an annual basis with respect to diagnostic, procedural and supply code changes.

• Ensures strict confidentiality of financial and medical records.

• Performs other related duties as required. This position may be assigned to special projects or accountabilities when other priorities are identified.

• Requires a High School diploma or GED; Certification in CPC, CCS, CCS-P; or specialty coding with one to three years experience directly related to coding and reimbursement for physician services; or equivalent combination of education and experience.

• Experience with Orthopedics, Neurosurgery, or Urology specialty physician coding is preferred.

• Knowledge of CPT, HCPCS procedure and professional supply codes and ICD-9-CM diagnosis codes used for billing services provided by physicians and licensed nonphysician providers.

• Knowledge of third party fee profiles and reimbursement requirements.

• Knowledge of current and developing issues and trends in medical coding procedures and requirements.

• Ability to exercise initiative, independent judgment, discretion and decision-making to achieve organizational objectives.

• Demonstrates an understanding of job responsibilities and uses appropriate knowledge and skills to effectively complete work.

• Must have high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy.

• A wide degree of creativity and latitude is expected.

• Analytical ability to gather and interpret data and develop, recommends, and implement solutions.

• Demonstrates courtesy to others and promotes mutual respect.

• Establish and maintain effective working relationships with physicians, non-physician providers, and compliance staff.

• Must be able to interact and communicate with individuals at all levels of the organization.