Certified Professional Coder Job Description and Top Skills

What is a Certified Professional Coder?

A Certified Professional Coder is responsible for reviewing medical records, abstracting relevant clinical information, and assigning appropriate medical codes using ICD-10, CPT, and HCPCS code sets. CPCs play a crucial role in healthcare reimbursement, ensuring accurate documentation and coding of patient encounters to facilitate claims processing, billing, and compliance with regulatory requirements.

Certified Professional Coder

Are you detail-oriented, analytical, and proficient in medical coding? We’re seeking motivated individuals to join our team as Certified Professional Coders (CPCs). As vital members of our healthcare organization, successful candidates will play a key role in accurately assigning medical codes to diagnoses, procedures, and services, ensuring compliance with coding guidelines and optimizing revenue cycle management.

As a Certified Professional Coder, you will have the opportunity to contribute to the financial integrity of our organization by maximizing revenue, minimizing claim denials, and ensuring compliance with coding and billing regulations.

The ideal candidate will possess a strong understanding of medical coding principles, excellent analytical skills, and the ability to work independently in a fast-paced, deadline-driven environment.

What Does a Certified Professional Coder Do?

Medical Coding and Abstracting:

  • Review medical records, encounter forms, and documentation to abstract relevant clinical information and assign appropriate medical codes (ICD-10-CM/PCS, CPT, HCPCS) to diagnoses, procedures, and services accurately and efficiently.

Coding Compliance and Documentation:

  • Ensure compliance with coding guidelines, payer policies, and regulatory requirements (HIPAA, CMS) governing medical coding practices, and review documentation for completeness, accuracy, and specificity to support code assignment.

Claims Processing and Revenue Cycle Management:

  • Assist in the preparation and submission of medical claims for reimbursement to insurance companies, Medicare, Medicaid, and other payers, ensuring accurate coding, billing, and documentation to optimize claim acceptance and reimbursement rates.

Coding Audits and Quality Assurance:

  • Conduct regular coding audits and reviews to assess coding accuracy, completeness, and compliance with coding guidelines, identify coding discrepancies and opportunities for improvement, and provide feedback and training to coding staff as needed.

Coding Education and Training:

  • Provide coding education and training to healthcare providers, coding staff, and other stakeholders to ensure understanding of coding principles, documentation requirements, and regulatory changes, and promote accurate and compliant coding practices.

Coding System Maintenance and Updates:

  • Stay informed about changes and updates to coding systems, coding guidelines, and regulatory requirements, and ensure coding systems and software are up-to-date and properly maintained to support accurate and efficient coding processes.

Coding Query Resolution:

  • Respond to coding-related inquiries from healthcare providers, coding staff, and other stakeholders, research coding issues, and provide guidance and clarification on coding rules, conventions, and guidelines to facilitate accurate code assignment.

Performance Reporting and Analysis:

  • Generate reports and analytics on coding productivity, accuracy, and compliance metrics, tracking key performance indicators (KPIs) such as coding accuracy rates, claim denial rates, and coding-related revenue impact.

How Much Do Certified Professional Coders Make?

The median annual salary for Certified Professional Coders in the United States is $49629. Entry-level positions typically start at $37,000 per year, while experienced practitioners can earn as much as $68,000 annually.

Skill Requirements

  • Medical Coding Knowledge: Certified Professional Coders must possess a strong understanding of medical coding principles, coding systems (ICD-10-CM/PCS, CPT, HCPCS), and coding guidelines to accurately assign medical codes and ensure compliance with coding regulations.
  • Attention to Detail: Certified Professional Coders should demonstrate attention to detail in reviewing medical records, abstracting clinical information, and assigning medical codes accurately, ensuring documentation and coding integrity and compliance.
  • Analytical Skills: Certified Professional Coders should have strong analytical skills to analyze medical records, interpret clinical documentation, and assign appropriate medical codes based on diagnoses, procedures, and services rendered.
  • Communication Skills: Certified Professional Coders should have effective communication skills to interact with healthcare providers, coding staff, and other stakeholders, conveying coding-related information clearly, professionally, and empathetically.
  • Problem-Solving Abilities: Certified Professional Coders should be proactive problem-solvers, capable of identifying and resolving coding discrepancies, coding-related issues, and compliance concerns efficiently and effectively.
  • Computer Proficiency: Certified Professional Coders should be proficient in using coding software, electronic health record (EHR) systems, and office productivity tools to input, retrieve, and manage coding information accurately and securely.

Example KPIs for a Certified Professional Coder

  • Coding Accuracy Rate: This KPI measures the percentage of accurately assigned medical codes, tracking coding accuracy rates and identifying coding discrepancies and opportunities for improvement to optimize documentation and revenue integrity.
  • Claim Denial Rate: This KPI tracks the percentage of denied medical claims due to coding-related issues, identifying root causes of claim denials, implementing corrective actions, and appealing denied claims to maximize reimbursement and minimize revenue loss.
  • Coding Productivity: This KPI evaluates coding productivity levels, assessing the number of medical records coded per hour or per day, and comparing coding output against industry benchmarks and organizational standards to optimize coding efficiency.
  • Coding Compliance Score: This KPI assesses coding compliance with coding guidelines, payer policies, and regulatory requirements, measuring coding accuracy, completeness, and consistency, and identifying areas for coding education and training.

How Can Glider AI Help You with Hiring a Certified Professional Coder?

Glider’s recruitment platform is designed to streamline the hiring process for Certified Professional Coders by leveraging AI-driven assessments and analytics.  Utilize Glider AI Skill Intelligence™ to identify top-quality candidates, streamline candidate screening, and ensure a mobile-first, candidate-friendly experience.

Glider AI’s Unique Features

Go ahead and spotlight your Certified Professional Coder with Glider AI today!

Schedule a Demo or contact us at info@glider.ai

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