Maintains a working knowledge of CPT, CDT and ICD-10 coding principles, governmental regulations, protocols and third-party requirements regarding billing and documentation. Interprets clinical data using working knowledge of anatomy, physiology, disease process and medica/dental terminology. Selects correct ICD-10-CM (diagnostic) and CPT-4 (procedural) codes based upon interpretation of operative procedure and correct coding principles. Queries when appropriate. Remains up to date on all coding changes and usage. Interprets current NCCI edits and applies “bundling” and “unbundling” rules according to payer requirements, if different from CPT-4 coding guidelines. Applies correct modifiers to procedure codes, when warranted, according to CPT-4 guidelines and Medicare/Carrier instructions.

Assures that all codes assigned are supported by documentation in the medical/dental record; if services are not documented appropriately, will seek to obtain proper documentation before submitting codes for billing. Achieves and maintains production quotas and accuracy as agreed to with supervisor. Works coding-related charge review and claim edits daily to ensure timely and accurate billing. May also include working denials queue.

Provides education regarding coding, billing and documentation to dentists and other ancillary staff as needed, ranging from individual, small group to lecture format. Researches and resolves coding related denials forwarded by insurance follow-up team.

Recommends changes to policies and procedures to improve professional fee coding and data management. Performs all aspects of daily work in a manner that contributes to and ensures an environment of strict confidentiality. Demonstrates the ability to be flexible, organized and function well in stressful situations. Attend Department specific meetings or related compliance meetings as requested.

Enhances professional growth and development through membership in professional organizations, participation at in-service meetings / educational programs, and departmental/division performance improvement activities, and by referencing resource materials and publications. Establishes and maintains professional working relationships with staff, including but not limited to, dentists, nursing, clinic staff, medical/dental records and revenue cycle staff.