Professional Fee Coder/Auditor

Overview

• Perform coding and auditing of professional fee records ensuring compliance with official coding guidelines and accuracy in diagnosis and procedure codes.
• Validate patient demographics, insurance carrier assignments, and financial classifications to ensure proper claim submission.
• Compose physician-friendly feedback and inquiries following prescribed workflows to enhance coding accuracy and compliance.
• Maintain a coding production rate of 95% or above while demonstrating proficiency in ICD-10 and CPT coding standards.
• Conduct claim editing, troubleshoot problem accounts, and perform root cause analysis to resolve coding issues.
• Utilize expertise in renal specialty coding and risk adjustment to audit and train others effectively.
• Work remotely in an autonomous environment, leveraging analytical skills and effective communication abilities.

Key Responsibilities & Duties

• Analyze and review medical records for accurate code assignment and compliance with coding guidelines.
• Prepare claims for submission by validating patient demographics and ensuring proper provider billing group classification.
• Compose compliant and physician-friendly feedback for coding validation audits and inquiries.
• Maintain coding logs and independently track production rates to ensure performance standards are met.
• Conduct claim editing activities and troubleshoot problem accounts, escalating issues as necessary.
• Utilize coding expertise in renal specialty and risk adjustment to audit and train team members.
• Collaborate with revenue cycle management leadership to address coding challenges and optimize processes.

Job Requirements

• High School Diploma or GED with 5+ years of combined education, experience, or certification in coding.
• Approved credential from AHIMA or AAPC, such as Certified Professional Coder.
• Proficiency in ICD-10 and CPT coding standards with a minimum accuracy rate of 95%.
• Experience in risk adjustment coding and holding an HCC Certified Coding Credential preferred.
• Skilled in creating compliant provider feedback and proficient in Microsoft Office applications.
• Proven ability to work autonomously in a remote environment with effective communication and analytical skills.
• Internet connectivity meeting minimum speed and latency requirements for remote work.