PB Coder II - Claim Edits

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Job Summary

JOB SUMMARY

The Coder II, Responsible for coding and abstracting procedural (CPT) and diagnosis codes (ICD-10) for physician services, reviewing physician documentation in the electronic medical record for completeness and accuracy to ensure proper code assignment, providing physician feedback of discrepancies/trends, resolving edits and denials, and releasing encounters for billing. Utilizes intermediate problem-solving skills to address coding related tasks of detailed, medium complexity. Duties include procedural (CPT) and diagnosis (ICD-10) coding for all places of service, including, but not limited to ER, observation, inpatient, outpatient, ambulatory surgery, and other ancillary services. Responsible for reviewing, analyzing, and interpreting physician documentation, CPT and diagnosis coding, charge entry, coding claim edit, and coding denial management for coding related tasks.

1. Review Clinical Documentation

• Review physician or provider documentation to identify services rendered.
   

2. Assign Appropriate Medical Codes

• Apply correct CPT, ICD‑10‑CM, and HCPCS codes for:
  • Evaluation & Management (E/M) services
  • Diagnostic and procedural services
  • Facility or professional fees
     

3. Ensure Compliance

• Validate that documentation supports billed services.
• Ensure coding follows:
  • Medicare/Medicaid regulations
  • CMS guidelines
  • CPT documentation standards
     

4. Resolve Coding Edits & Denials

• Navigate EMR work queues (e.g., Epic) to address claim edits and charge review items.
• Resolve coding‑related denials to support accurate reimbursement.
   

Quality Assurance & Productivity

5. Maintain Productivity & Quality Standards

• Meet hourly productivity and accuracy standards set by enterprise coding teams.
   

6. Conduct Quality Audits

• Perform audits within specialty areas to ensure coding accuracy and identify improvement opportunities.
   

Collaboration & Communication

7. Provide Education & Feedback

• Educate providers on documentation and billing requirements.
• Communicate trends in coding errors and denials.
   

8. Collaborate Across Teams

• Work with billing departments, coding leadership, and clinicians to resolve billing or documentation concerns.
   

Administrative & Support Tasks

9. Enter and Validate Billing Data

• Perform accurate charge entry and ensure all billing information is complete.
   

10. Develop Process Documentation

• Create workflows, tip sheets, and written procedures to improve coding processes and train peers.

QUALIFICATIONS:

2 + years Relevant coding and abstracting experience in an acute care hospital.

     Experience with Epic, 3M CAC and HDM systems.

EDUCATION:

Highschool Diploma Or GED

CERTIFICATION
Certified Professional Coder (CPC) or

CCS-P, CCS-H, RHIA, RHIT, or equivalent coding certification

Core Competencies
These competencies reflect the values and behaviors expected of all Grady team members, regardless of role. They ensure that every employee contributes to safe, high-quality care, positive patient experience, and a collaborative work environment.

1. Patient-Centered Care – Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families.
2. Integrity & Accountability – Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes.
3. Collaboration & Teamwork – Builds positive relationships, works effectively across departments, and supports colleagues to achieve shared goals.
4. Communication – Communicates clearly, respectfully, and effectively with patients, families, colleagues, and leadership.
5. Respect & Inclusion – Creates an inclusive environment by valuing diversity, treating others with dignity, and ensuring equitable care and opportunities for all.
6. Quality & Safety – Adheres to best practices, regulatory standards, and policies to ensure safe, reliable, and high-quality outcomes.
7. Adaptability & Resilience – Responds effectively to change, remains flexible in dynamic situations, and demonstrates resilience under pressure.
8. Continuous Improvement – Seeks opportunities to improve processes, skills, and outcomes through innovation, learning, and feedback.
9. Leadership & Professionalism – Inspires, guides, and develops individuals and teams while modeling professionalism, fairness, and transparency.
10. Employee Experience Focus – Champions a supportive and engaging employee journey that enables staff to thrive and, in turn, deliver exceptional patient care.

Grady Total Rewards
At Grady, we believe in supporting the health, well-being, and growth of every team member. Our Total Rewards package is designed to provide competitive pay and comprehensive benefits that make a difference in your life and career, including:

• Health & Wellness: Medical, dental, vision, and prescription drug coverage.

• Financial Security: Retirement savings plans with employer contributions, life insurance, and disability coverage.

• Work-Life Balance: Paid time off, holidays, and family leave benefits.

• Career Growth: Tuition reimbursement, professional development programs, and opportunities for advancement.

• Employee Support: Employee Assistance Program (EAP), wellness initiatives, and discounts on services.

Grady’s Total Rewards are designed to ensure our employees feel valued, supported, and empowered, both at work and beyond.

Why Join Grady?
Grady Health System is more than a hospital — we are a vital part of Atlanta and the surrounding communities. For over 125 years, Grady has been committed to providing exceptional care, advancing health equity, and making a difference in the lives of those we serve. When you join Grady, you become part of a team that values excellence, compassion, innovation, and collaboration.

Here, every role matters. Whether you provide direct patient care, support our operations, or lead teams, you play an important part in fulfilling our mission. We offer opportunities to learn, grow, and build a meaningful career in an environment where your contributions are recognized and valued.

At Grady, we don’t just work,  we make an impact.

Equal Opportunity Employer Statement:
Grady Health System is proud to be an equal opportunity employer. We are committed to fostering a workforce where all employees feel valued, respected, and empowered to succeed. We prohibit discrimination and harassment of any kind based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic. 

Grady is dedicated to creating an accessible work environment and provides reasonable accommodations to qualified individuals with disabilities to ensure equitable opportunities for success.