Patient Financial Concepts

Professional Fee Coder The Professional Fee Coder (ProFee) is responsible for reviewing provider documentation and assigning accurate ICD-10-CM, CPT, and HCPCS codes for physician professional services. This role supports compliant coding, timely charge capture, and clean claim submission in accordance with AMA, CMS, and payer guidelines. Responsibilities include, but are not limited to: Review provider documentation and assign ICD-10-CM, CPT, HCPCS Level II codes, and applicable modifiers for professional fee services. Select appropriate Evaluation and Management (E/M) levels based on current guidelines (MDM and/or time and ensure documentation supports code selection. Apply modifier and global surgery rules accurately (e.g., 25, 24, 57, 58, 59, 78, 79) and comply with NCCI edits and payer policies. Ensure medical necessity and proper linkage of diagnoses to services; identify and resolve coding edits prior to claim submission when applicable. Query providers for...

Inpatient Coding Auditor The Inpatient Coding Auditor is responsible for auditing inpatient coding and DRG assignment to ensure accurate ICD-10-CM/PCS coding, documentation support, and compliance with official guidelines and payer requirements. This role tracks audit outcomes, supports corrective actions, and provides education to improve coding quality and reduce audit risk. Responsibilities include, but are not limited to: Review entire medical record to confirm correct assignment of ICD-10-CM/PCS coding, sequencing and POA to ensure proper assignment of MS-DRG/APR-DRG. Review clinical documentation for guideline compliance, clinical support, and accurate capture of CC/MCC and key secondary diagnoses and procedures. Identify trends, root causes, and compliance risks; recommend corrective actions and process improvements in collaboration with coding leadership and CDI. Work closely with leadership create and prepare detailed audit reports, including findings,...

Job TypePart-timeDescriptionRequired :3-5 years of experience in acute care facility (hospital) medical coding auditing or complianceLocation :RemoteJob Summary :The Medical Coding Auditor is responsible for reviewing medical records to ensure accurate coding and compliance with regulatory requirements.This role ensures continuous quality improvement in coding practices while maintaining compliance with healthcare laws and organizational policies.Occasional travel may be required for audits or meetings.Key Responsibilities :Conduct reviews and audits of medical records for coding accuracy (ICD-10-CM, CPT, HCPCS) and documentation compliance.Ensure compliance with federal, state, and payer-specific regulations, including CMS guidelines.Identify and address coding discrepancies and recommend corrective actions.Prepare detailed audit reports with findings and provide feedback on documentation and coding practices.Collaborate with relevant departments to resolve audit findings and...