Description
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.
Required: Inpatient Neonatal, pediatric, and critical care professional fee coding experience
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 clarification when documentation is incomplete or ambiguous, following compliant query practices.
- Meet established productivity, accuracy, and turnaround time standards to support billing and revenue cycle goals.
- Collaborate with billing/denials teams to resolve coding-related rejections and provide supporting rationale for appeals as needed.
- Maintain confidentiality and comply with HIPAA and organizational policies when handling protected health information.
- Stay current with coding guideline updates, payer changes, and compliance requirements; complete required continuing education.
- Participate in internal quality reviews and implement corrective actions to improve coding accuracy.
Requirements:
- 3+ years of recent professional fee (physician) coding experience; multi-specialty experience preferred.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, NCCI edits, and payer guidelines.
- Experience applying current E/M coding guidelines and common professional fee compliance requirements.
- Proficiency with EHR and encoder/coding tools (e.g., Epic, Cerner, 3M, Optum) and Microsoft Office.
- Excellent attention to detail, analytical skills, and ability to manage multiple priorities.
- Effective communication skills for provider/coder collaboration and documentation clarification.
- Active coding certification required (CPC or CCS/CCA); CPMA or specialty credential is a plus.
- Must be credentialed from AAPC or AHIMA, AAPC preferred.
About Us:
PF Concepts is a growing healthcare revenue cycle company committed to quality, integrity, teamwork, and continuous growth. We partner with healthcare organizations to improve financial performance through strong relationships, personalized solutions, and high service standards.
