Required Skills & Experience• 3+ years of professional fee coding experience. • Active coding certification through AAPC or AHIMA. • Active RHIT, RHIA, CPC, COC, CCS-P, CCS, CEDC, or equivalent coding credential. • Experience coding clinic visits/professional services. • Strong experience with Evaluation & Management (E/M) coding, diagnosis coding, injections, and procedure coding. • Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and coding compliance guidelines. • Experience with Cerner EMR. • Experience working remotely. • Proficiency in Microsoft Outlook, Excel, and Teams. Strong communication, organization, and multitasking skills.
Nice to Have Skills & Experience• Emergency Department (ED) coding experience. • Multi-specialty Pro-Fee coding background. • Experience with regulatory reporting and data abstraction. • Prior hospital or health system coding experience. • Experience partnering with AR/billing teams on claim resolution. • History of exceeding coding productivity and quality metrics. • Experience mentoring, training, or educating other coders. Additional AAPC or AHIMA certifications beyond minimum requirements.
Day-to-Day Responsibilities • Review and code professional fee encounters using ICD-10-CM, CPT, and HCPCS guidelines. • Assign accurate E/M levels, diagnoses, and procedure codes to ensure compliant reimbursement. • Abstract key patient and encounter data for billing, regulatory, and reporting purposes. • Audit medical records to ensure documentation supports services billed and identify documentation gaps. • Communicate with physicians and providers to obtain coding and documentation clarifications. • Review and resolve coding-related claim edits, including medical necessity and NCCI/CCI edits. • Collaborate with billing and Accounts Receivable teams to resolve coding and reimbursement issues. • Maintain quality and productivity standards while meeting a 95% coding accuracy requirement. • Work within EMR, hospital information systems, and encoder software in a fully remote environment. Stay current on coding regulations, payer requirements, and continuing education requirements.