ProFee Coder - Internal Medicine
About The Position
The Professional Coder is responsible for accurately assigning ICD-10-CM, CPT, HCPCS Level II, and applicable modifiers for physician and other qualified healthcare professional services. This role ensures coding accuracy, documentation integrity, and compliance with official coding guidelines, regulatory requirements, and payer-specific policies. The coder reviews clinical documentation to capture diagnoses, procedures, and services performed in outpatient and professional settings, supporting appropriate reimbursement, minimizing claim denials, and ensuring high-quality, compliant coding that contributes to overall revenue integrity and data accuracy.
Requirements
- Advanced knowledge of ICD-10-CM, CPT, HCPCS Level II, and modifier assignment for physician and other qualified healthcare professional services.
- Strong understanding of professional coding guidelines, including CPT Assistant, Coding Clinic guidance, and AMA/CMS documentation standards.
- Proficiency in applying Official Coding Guidelines and payer-specific policies for outpatient and professional services.
- Knowledge of medical terminology, anatomy, physiology, pharmacology, and disease processes to support accurate code assignment.
- Ability to accurately interpret clinical documentation to assign diagnoses, procedures, and services at the professional level.
- Experience applying NCCI edits and payer-specific claim editing rules to ensure compliant coding and reduce denials.
- Understanding of medical decision-making (MDM) concepts and documentation requirements supporting professional E/M services (if applicable to role scope).
- Minimum of 2–4 years of professional (physician-based) coding experience in a multi-specialty, hospital-based physician group, or outpatient environment.
- Active certification from AHIMA or AAPC such as: CPC, CCS, RHIT.
- EPIC experience required.
- Must pass a client coding assessment with a score of 80% or higher.
- Ability to maintain required CPH (charts per hour) and accuracy standards.
- US based candidates only.
Responsibilities
- Accurately assign ICD-10-CM, CPT, HCPCS Level II, and applicable modifiers for physician and other qualified healthcare professional services.
- Ensure coding accuracy, documentation integrity, and compliance with official coding guidelines, regulatory requirements, and payer-specific policies.
- Review clinical documentation to capture diagnoses, procedures, and services performed in outpatient and professional settings.
- Support appropriate reimbursement and minimize claim denials.
- Ensure high-quality, compliant coding that contributes to overall revenue integrity and data accuracy.
- Apply NCCI edits and payer-specific claim editing rules to ensure compliant coding and reduce denials.
- Identify coding discrepancies, documentation gaps, and claim issues impacting reimbursement and compliance.
- Research coding questions using authoritative resources such as CMS guidelines, CPT Assistant, Coding Clinic, and payer policies.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
