Professional Fee Coder/Auditor

Overview

• Perform coding and auditing of professional fee records ensuring compliance with official guidelines.
• Validate patient demographics, insurance, and other data fields for accurate claim submission.
• Compose physician-friendly feedback and inquiries following prescribed workflows.
• Utilize expertise in renal specialty coding, auditing, and training others as needed.
• Maintain a coding production rate and accuracy of 95% or above.
• Conduct claim editing activities, troubleshoot issues, and perform root cause analysis.
• Report to the Manager of Revenue Cycle Management and collaborate with leadership.
• Work remotely in an autonomous environment with reliable internet connectivity.

Key Responsibilities & Duties

• Analyze and review medical records to ensure accurate code assignment.
• Prepare daily coding logs and track production independently.
• Conduct audits and provide feedback related to code validation.
• Demonstrate proficiency in ICD-10 and CPT coding standards.
• Prepare claims for submission ensuring proper provider billing group classification.
• Compose compliant verbiage for provider feedback processes.
• Troubleshoot problematic accounts and escalate issues as needed.
• Train and mentor others in coding and auditing practices.

Job Requirements

• High School Diploma or GED required; additional certifications preferred.
• Approved credential from AHIMA or AAPC, such as Certified Professional Coder.
• Minimum of 3 years coding experience; 5 years preferred.
• Expertise in risk adjustment coding and HCC certified coding credential preferred.
• Proficiency in Microsoft Office applications and internet connectivity requirements.
• Strong analytical skills and ability to work autonomously.
• Experience in renal care or value-based care environments is advantageous.
• Excellent written and verbal communication skills.