Job Summary:

The Certified Professional Coder (CPC) is responsible for accurate review, abstraction, coding, and charge validation of professional and facility services for a large multi-site pain management practice and Ambulatory Surgery Center (ASC). This position ensures all services are coded in compliance with federal and state regulations, payer guidelines, National Correct Coding Initiative (NCCI) edits, and organizational policies.

The CPC will review provider documentation to accurately assign CPT®, HCPCS, and ICD-10-CM codes for office visits, interventional pain procedures, ASC procedures, fluoroscopy, ultrasound guidance, and related ancillary services. The coder serves as a resource for physicians, advanced practice providers, clinical staff, and revenue cycle teams regarding documentation and coding requirements.

Essential Functions:

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Coding & Documentation Review:

Review physician, APP, and ASC operative documentation for completeness and coding accuracy.
Assign appropriate ICD-10-CM, CPT, and HCPCS codes for pain management services and procedures.
Ensure coding is supported by medical documentation and complies with official coding guidelines.
Apply payer-specific billing requirements and modifier usage.
Review and validate Evaluation & Management (E&M) services based on current CMS and AMA guidelines.
Audit and code operative reports for ASC facility billing.
Verify medical necessity requirements and diagnosis-to-procedure linkage.
Correct coding errors and identify documentation deficiencies prior to claim submission.
Review and resolve coding edits, claim rejections, and coding-related denials.

Pain Management Procedure Coding

Accurately code services including but not limited to:

Epidural steroid injections.
Facet joint injections.
Medial branch blocks.
Radiofrequency ablation (RFA).
Sacroiliac joint injections.
Peripheral nerve blocks.
Sympathetic nerve blocks.
Trigger point injections.
Joint injections and aspirations.
Spinal cord stimulator trials and implants.
Intrathecal pain pump procedures.
Kyphoplasty and vertebroplasty.
Fluoroscopic and ultrasound guidance.
Regenerative medicine procedures when applicable.

ASC Facility Coding Responsibilities:

Review operative reports and facility documentation.
Assign ASC procedure codes and revenue codes as appropriate.
Ensure coding supports facility claim submission and reimbursement.
Maintain knowledge of Medicare ASC payment methodologies and commercial payer requirements.
Collaborate with ASC leadership regarding documentation and coding opportunities.

Compliance & Quality Assurance:

Maintain coding accuracy standards established by the organization.
Participate in routine internal coding audits.
Assist with responding to payer audits, RAC, CERT, UPIC, and commercial payer review requests.
Identify compliance concerns and report findings to leadership.
Remain current on coding changes, regulations, and payer updates.

Provider Education:

Educate physicians and APPs regarding coding, documentation, and reimbursement requirements.
Participate in provider documentation improvement initiatives.
Provide feedback regarding coding trends, audit findings, and documentation gaps.

Revenue Cycle Collaboration:

Work closely with Charge Entry, Billing, Accounts Receivable, and Credentialing teams.
Assist with coding-related appeals and denial management efforts.
Support revenue optimization initiatives while maintaining compliance standards.
Participate in implementation and optimization of EHR and practice management systems.

Required Qualifications:

Current AAPC Certified Professional Coder (CPC) certification required.
High school diploma or equivalent required.
Minimum 3 years of professional medical coding experience.
Minimum 2 years of pain management coding experience preferred.
Experience coding surgical and interventional pain procedures.
Strong understanding of:
- CPT coding
- ICD-10-CM coding
- HCPCS Level II coding
- Modifier assignment
- NCCI edits
- CMS regulations
- Medical necessity requirements
Experience with electronic medical record (EMR/EHR) systems and practice management software.
Proficiency with Microsoft Office Suite.

Preferred Qualifications:

Certified Professional Medical Auditor (CPMA).
Certified Outpatient Coder (COC).
Certified Ambulatory Surgery Center Coder (CASCC).
Associate degree in Health Information Management, Healthcare Administration, or related field.
ASC facility coding experience.
Multi-specialty surgical coding experience.

Jax Spine & Pain Centers

Charge Entry/Certified Professional Coder (CPC)

About the Job