General Summary of Duties: The primary duties of the CPC is to review the health record and assign CPT, and/or HCPCS, and diagnosis codes based on medical documentation. Query the physician for unclear documentation. Resolve all claim edits and rejections related to coding. 

Essential Functions:

• Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices 
• Audit medical record documentation to identify under-coded and up-coded services; prepare reports of findings and meet with providers and provide education and training on accurate coding practices and compliance issues 
• Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specified documentation
• Submit any issues or trends found within documentation by a physician and/or physician extender to management
• Research, analyze, and respond to inquiries regarding compliance, inappropriate coding, denials, and billable services
• Interact with providers and management to review and/or implement codes and to update charge documents
• Other duties as assigned 
   

Knowledge, Skills, and Abilities:

• Strong knowledge of anatomy, physiology and medical terminology
• Excellent typing and 10-key speed and accuracy
• Commitment to a high level of customer service
• Strong oral and written communication skills
• Working knowledge of medical jargon and anatomy preferred
• Able to work independently and in a group setting

• Working knowledge of Next Gen billing, Genius Doc, and I Know Med (preferred)

Qualifications: 

• High School Diploma or GED
• Minimum of two years’ experience in coding and auditing. Preferably in radiation oncology, rheumatology, labs, hematology and/or oncology
• Proficient computer skills
• Certified coding certificate from an accredited organization, such as AHIMA, or AAPC