What does a certified professional coder do?
A certified professional coder oversees the daily medical coding operations of a medical facility, ensuring compliance with industry standards and regulations. They usually have the responsibility to provide coding to facilities, update databases, and conduct reviews and assessments to identify missing details or inconsistencies and perform corrective measures. Moreover, as a certified professional coder, it is essential to coordinate with external parties such as insurance providers and communicate with patients, assisting them by answering inquiries, explaining procedures, and solving issues and concerns if any would arise.
Certified professional coder responsibilities
Here are examples of responsibilities from real certified professional coder resumes:
- Manage the outsourced transcription company.
- Apply ICD-10-CM, CPT-4 codes and modifiers in accordance with federal regulations.
- Validate DRG's for inpatient and inpatient RAC appeals as well as validating DRG changes.
- Assist with insurance verification and registration, including Medicare and Medicaid.
- Review, analyze, and code all ICD-9-CM and ICD-10-CM diagnoses.
- Work all age reports for all Medicaid.
- Assign ICD-9-CM, CPT-4, HCPC codes accurately and timely.
- Work alongside utilization review nurses to ensure proper assignment of DRG.
- Assign correct medical codes following CPT & ICD-9 guidelines to radiology and surgery reports.
- Perform internal chart audits to ensure proper documentation/code is utilized, as well as all appeals.
- Conduct inventory and monitor activities of claims, service requests (medical records review) and appeals.
- Code all inpatient, outpatient, observation and out patient surgery accounts with ICD9, ICD10 and CPT4
- Code and bill out charges submit to EHR system by providers, verifying CPT and ICD codes.
- Analyze provider documentation to assure the appropriate E/M levels are assign using the correct CPT codes.HCC coding project.
- Perform coding for oncology, diabetes, and cardiovascular trials for multiple sponsors following sponsor guidelines and ClinDatrix standards.
Certified professional coder skills and personality traits
We calculated that 20% of Certified Professional Coders are proficient in CPC, Medical Terminology, and AAPC. They’re also known for soft skills such as Analytical skills, Detail oriented, and Integrity.
We break down the percentage of Certified Professional Coders that have these skills listed on their resume here:
- CPC, 20%
Assist with enrolling students in the AAPC Professional Medical Coding program, assist with proctoring AAPC CPC examinations.
- Medical Terminology, 9%
Translate dental terminology to medical terminology to bill medical insurances for certain procedures performed in the dental field.
- AAPC, 8%
Attended quarterly Piedmont Association of Coders (PAC) and American Association of Professional Coders (AAPC) meetings and seminars.
- Patients, 7%
Formulated and implemented standard operating procedures regarding appropriate documentation for different service levels rendered to patients.
- ICD-10-CM, 5%
Review complex medical records and accurately code primary/secondary diagnosis and procedures using ICD-10-CM and or CPT/HCPS coding conventions.
- E/M, 4%
Maintain compliance of physician fee schedule/charges for outpatient charges (E/M codes/Inpatient/Observation/Consults, Nursing Facility Care, etc.).
Most certified professional coders use their skills in "cpc," "medical terminology," and "aapc" to do their jobs. You can find more detail on essential certified professional coder responsibilities here:
Analytical skills. The most essential soft skill for a certified professional coder to carry out their responsibilities is analytical skills. This skill is important for the role because "health information technicians must understand and follow medical records and diagnoses, and then decide how best to code them in a patient’s medical records." Additionally, a certified professional coder resume shows how their duties depend on analytical skills: "read eob's and data entry.was a 7 physician practicebecame a cpc though the aapc in 2001"
Detail oriented. Many certified professional coder duties rely on detail oriented. "health information technicians must be accurate when recording and coding patient information.," so a certified professional coder will need this skill often in their role. This resume example is just one of many ways certified professional coder responsibilities rely on detail oriented: "detailed understanding of coding guidelines as well as medicare medical necessity issues. "
Integrity. Another skill that relates to the job responsibilities of certified professional coders is integrity. This skill is critical to many everyday certified professional coder duties, as "health information technicians work with patient data that are required, by law, to be kept confidential." This example from a resume shows how this skill is used: "certified professional coder (cpc)trusthcs is a consulting firm for hospital and physicians in the us. "
Technical skills. certified professional coder responsibilities often require "technical skills." The duties that rely on this skill are shown by the fact that "health information technicians must use coding and classification software and the electronic health record (ehr) system that their healthcare organization or physician practice has adopted." This resume example shows what certified professional coders do with technical skills on a typical day: "utilized technical coding principles and expertise to assign icd-9-cm diagnoses, hcpcs and cpt-4 procedures. "
The three companies that hire the most certified professional coders are:
- Cleveland Clinic12 certified professional coders jobs
- Danbury Hospital10 certified professional coders jobs
- Emory Healthcare8 certified professional coders jobs
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Certified professional coder vs. Records manager
The records manager is an important position that handles the creation, organization, and disposal of records. They are also responsible for establishing systems for their management and the maintenance, verification, and evaluation of extant systems. It will require technical and analytical skills, as well as a great deal of integrity for handling sensitive information.
While similarities exist, there are also some differences between certified professional coders and records manager. For instance, certified professional coder responsibilities require skills such as "cpc," "medical terminology," "aapc," and "patients." Whereas a records manager is skilled in "office equipment," "access database," "sharepoint," and "dod." This is part of what separates the two careers.
Records managers really shine in the professional industry with an average salary of $58,862. Comparatively, certified professional coders tend to make the most money in the technology industry with an average salary of $58,073.On average, records managers reach higher levels of education than certified professional coders. Records managers are 7.1% more likely to earn a Master's Degree and 1.5% more likely to graduate with a Doctoral Degree.Certified professional coder vs. Records specialist
Records Specialists are administrative professionals who help manage the records of the company. These records may be physical documents or digital copies that are stored in a database. Records Specialists may assist in creating filing systems and knowledge management systems to ensure that the records they keep are easily accessible. They also keep an organized list or database of all the documents that are with them. Records Specialists are in charge of pulling up records upon the request of different departments or individuals. If they are working with physical copies, they ensure that these documents are returned to them. If they are working with digital copies, they ensure that the files they share are kept confidential. Records Specialists may also be in charge of analyzing trends and creating records-related reports.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that certified professional coder responsibilities requires skills like "cpc," "medical terminology," "aapc," and "patients." But a records specialist might use other skills in their typical duties, such as, "customer service," "office equipment," "word processing," and "database systems."
Records specialists may earn a lower salary than certified professional coders, but records specialists earn the most pay in the government industry with an average salary of $37,273. On the other hand, certified professional coders receive higher pay in the technology industry, where they earn an average salary of $58,073.Average education levels between the two professions vary. Records specialists tend to reach similar levels of education than certified professional coders. In fact, they're 2.1% more likely to graduate with a Master's Degree and 1.5% more likely to earn a Doctoral Degree.Certified professional coder vs. Information management specialist
An information management specialist is responsible for maintaining the security benchmark of all databases across the organization to support business functions and client requirements. Information management specialists sort and file data on the network systems and pull up reports from the storage database. They also analyze project management plans and utilize data tools to identify solutions and collect critical information. An information management specialist handles data management system troubleshooting and provide resolution reports to avoid downtime reoccurrence.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from certified professional coder resumes include skills like "cpc," "aapc," "icd-10-cm," and "e/m," whereas an information management specialist is more likely to list skills in "customer service," "patient care," "cycle management," and "phone calls. "
Information management specialists earn the best pay in the technology industry, where they command an average salary of $66,785. Certified professional coders earn the highest pay from the technology industry, with an average salary of $58,073.Most information management specialists achieve a higher degree level compared to certified professional coders. For example, they're 5.4% more likely to graduate with a Master's Degree, and 0.8% more likely to earn a Doctoral Degree.Certified professional coder vs. Reimbursement specialist
A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.
Even though a few skill sets overlap between certified professional coders and reimbursement specialists, there are some differences that are important to note. For one, a certified professional coder might have more use for skills like "cpc," "aapc," "icd-10-cm," and "e/m." Meanwhile, some responsibilities of reimbursement specialists require skills like "customer service," "cpt," "hcpcs," and "eob. "
In general, reimbursement specialists earn the most working in the pharmaceutical industry, with an average salary of $41,366. The highest-paying industry for a certified professional coder is the technology industry.The average resume of reimbursement specialists showed that they earn similar levels of education compared to certified professional coders. So much so that theyacirc;euro;trade;re 1.3% more likely to earn a Master's Degree and more likely to earn a Doctoral Degree by 0.2%.Types of certified professional coder
Updated January 8, 2025
