Professional Coding and Documentation Improvement Specialist

Job Description:

• Facilitate compliant physician coding and documentation for accurate assignment of diagnosis, Evaluation and Management (E&M), and Current Procedural Terminology (CPT) codes
• Monitor medical record documentation content to ensure compliance with industry guidelines, laws, and regulations
• Provide provider feedback and education on proper documentation to support code-level selections
• Identify and report recurring coding and documentation improvement areas to leadership
• Review and respond to requests for coding and documentation education
• Support proactive documentation improvement initiatives within Capital Health Medical Group
• Review medical record documentation for accurate assignment and support of diagnosis, CPT, and E&M codes
• Monitor provider-selected E&M codes to ensure documentation supports medical necessity, code specificity, and compliance
• Develop and deliver education materials promoting clear, accurate, and complete documentation
• Meet or exceed departmental accuracy and productivity standards
• Communicate documentation opportunities and monitoring results clearly and constructively to providers
• Foster teamwork and collaboration
• Attend hospital and medical staff meetings regarding documentation issues
• Partner with revenue cycle teams to resolve complex coding-related issues
• Support professional coders with pre-bill edits as needed
• Facilitate changes required to capture needed documentation on EMR templates
• Assist in appeals resulting from third-party reviews
• Act as a subject matter expert for professional coding and documentation improvement questions
• Perform other duties as assigned

Requirements:

• High School Diploma or equivalent
• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician-based (CCS-P) required
• Physician coding and Training certification
• Two years’ experience in professional coding role
• ICD-10-CM, CPT, CM, and HCPCS coding experience
• Excellent verbal and written communication skills
• Knowledge of pathophysiology and disease processes
• Strong knowledge of industry guidelines and laws for physician coding and reimbursement
• Research and analysis skills
• Proficient with Microsoft Outlook, Word, Excel, and PowerPoint
• Medical Terminology, Anatomy and Physiology, or Pathophysiology knowledge
• Ability to develop, implement, deliver, and assess coding education plans using a variety of methods
• Ability to work using multiple EMR systems
• Ability to work collaboratively and independently
• Candidates must be located in New Jersey, Pennsylvania, or Alabama

Benefits:

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA), including Healthcare FSA and Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance, including Voluntary Life Spouse, Voluntary Life Employee, and Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program
• Bonus and/or incentive eligibility determined by role and level