Job Description:
Title: Certified Professional Coder
Location: Ewing, NJ
Duration: Full Time
Job Summary:
This position is accountable for the review, interpretation and codification of Medical Policies and Legislative Mandates utilizing CPT-4, HCPC and ICD-9/ICD-10 coding parameters.
Responsibilities:
• Reviews and interprets current Medical Policies for systematization.
• Translates written policy interpretation into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.
• Translates Legislative Mandates into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.
• Maintains a database for all policies and mandates that is updated each time new/revised/deleted CPT/HCPC/ICD-9/ICD-10 are released.
• Monitor compliance with policies and procedures relevant to clinical data reviewed.
• Perform updates to the criteria file to include adds/deletes/revisions of CPT-4 and HCPC codes. Review all codes for accuracy; review database to criteria file before implementation of policy.
• Handle internal and external areas requests to investigate current state and historical of changes made to a particular CPT-4/HCPC/Diagnosis code such as effective dates, messages used, parameter limitations.
• Review and analyze BRD/TRD/Summary to ensure accuracy of implementation of policies.
• Review of scripts concerning Edits in criteria file. Review logic concerning implementation of policies.
• Assist benefit file on criteria loading to best accommodate implementation of benefits.
• Ensure files (provider/criteria) are loaded correctly in order to receive proper Edits 405/406.
• Perform other related tasks as assigned.
Knowledge:
• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.
• Requires knowledge of anatomy, physiology and medical terminology of medical procedures, abbreviations and terms.
• Requires knowledge of the health care delivery system.
Skills and Abilities:
• Requires the ability to utilize a personal computer and applicable software ( e.g. proficiency in Word, Excel, Access).
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
• Demonstrated ability to deliver highly clinical information to technical individuals.
• Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.
• Must have the ability to organize/prioritize/analyze complex tasks.
• Use of CMS website for CCI rules and regulations.
• Use of other approved websites for research.