Senior Physician Coder

Kootenai Health, Inc.; Coeur d'Alene (ID); On-site; USD 62,000 - 103,000; Full time

Benefits offered by this job

Insurance plans

Tuition assistance

Retirement plan

Night/weekend shift differentials

Employee referral bonus

Job summary

Kootenai Health in Idaho is seeking a Senior Physician Coder to serve as the advanced technical resource for professional services coding. You will ensure accurate, compliant coding and complete charge capture, while auditing complex encounters and educating coders, providers, and staff.

You will partner with Billing, AR, Revenue Integrity, and Hospital Coding to reduce denials and support appropriate reimbursement, applying ICD-10-CM, CPT, HCPCS and E/M guidelines across multiple specialties.

Qualifications

• Associate degree in health information management; 2 years of related experience may be accepted in lieu of degree.
• Minimum 5 years’ professional services (physician/clinic) coding experience across multiple specialties.
• Advanced knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and E/M guidelines across multiple specialties.

Responsibilities

• Reviews and codes complex professional services encounters across multiple specialties.
• Audits coded encounters, tracks errors, and educates coders, providers, and staff.
• Collaborates with Billing, AR, Revenue Integrity, and Hospital Coding to improve charge capture and reduce denials.

Skills

ICD-10-CM expertise

CPT/HCPCS knowledge

E/M guidelines

Auditing

Training delivery

Data analysis

Epic experience

Communication

Education

Associate degree in Health Information Management

Tools

Epic Systems

Excel

Job description

Position Summary

Senior Physician Coder serves as the advanced technical resource for professional services (physician/clinic) coding, ensuring accurate, compliant coding and complete charge capture across multiple specialties and payers. This role codes complex encounters, audits coded charges, and provides education to coders, clinic providers, and staff. This role partners with Billing, AR, Revenue Integrity, and Hospital Coding to reduce denials and support appropriate reimbursement.

Responsibilities

• Reviews, interprets, and codes complex professional services encounters across multiple specialties, applying coding regulatory requirements and multiple payer guidelines
• Ensures full, compliant coding and charge capture for reimbursement, billing, and denial analysis
• Audits coded encounters and charges, tracks errors and trends, and provides real-time feedback and education to coders, clinic providers, and staff
• Serves as a technical resource and subject matter expert for coding staff, resolving complex coding questions and assisting with training, onboarding, and the development of training materials
• Analyzes denials, productivity, and other coding performance data, conducts root cause analysis, and recommends and helps implement corrective actions
• Collaborates with clinic providers, clinic staff, Billing, AR, Revenue Integrity, and Hospital Coding to resolve coding and charge capture issues and increase efficiencies and revenue related to coding
• Monitors regulatory and payer guideline updates and helps develop and update coding policies, processes, and procedures to ensure compliance
• Meets or exceeds established productivity and quality standards, and covers coding and auditor/trainer areas as necessary
• Exercises discretion to establish new coding compliance policies or organizational standards
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Performs other related duties as assigned
• Competent to meet age-specific needs of the unit assigned

Requirements and Minimum Qualifications

• Associate’s degree in health information management or related field; 2 years of related experience may be accepted in lieu of degree
• Minimum 2 years’ coding auditing experience preferred
• Minimum 5 years’ professional services (physician/clinic) coding experience for various specialties
• Experience preparing and delivering training materials to individuals and staff groups preferred
• Advanced knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and E/M guidelines across multiple specialties
• Knowledge of CMS and multiple payer coding, billing, and charge capture requirements
• Previous Epic experience required
• Strong knowledge of anatomy, physiology, medical terminology, and disease processes
• Ability to analyze data and conduct root cause analysis of denials
• Excel experience preferred
• Ability to develop and deliver education to coding staff, clinic providers, and clinic staff
• Effective communication skills for serving as a liaison with clinic providers, staff, and revenue cycle teams

Working Conditions

• Must be able to maintain a sitting position
• Typical equipment used in an office job
• Repetitive movements

A variety of medical, dental, and vision insurance plans are available to both full and part-time employees, with some available at no cost to the employee. In addition, benefit-eligible employees also gain access to the following:

• Tuition assistance and career development programs
• Robust Retirement Plan
• Night, weekend and PRN shift differentials
• Employee referral bonus program