ProFee Coding Specialist III - Remote

Children's Wisconsin•West Allis, WI

2d•Remote

About The Position

The ProFee Coding Specialist III collaborates with ancillary or specialty departments, locations, and providers to code, review, and release charges in a timely manner while ensuring correct coding, billing compliance, and complete charge capture. The specialist works with providers and departmental staff and leaders on coding and charge-capture questions. This is a 100% remote, full-time position scheduled Monday through Friday for 40 hours per week. The role may cover multiple medical or surgical specialties and may serve as a subject matter expert in one or more specialties. It includes resolving charge edits, supporting accurate charge capture, identifying denial-reduction opportunities, and maintaining protocols and processes for assigned areas.

Requirements

At least three years of experience coding professional-fee E/M services for multiple specialties.
Experience coding bedside procedures in an inpatient setting.
Experience working claim edits and denials.
High school diploma, GED, or HSED.
Knowledge of ICD-10, CPT, and HCPCS coding guidelines.
Working knowledge of CCI edits, healthcare insurance guidelines, and other regulatory guidance.
Excellent oral and written communication skills.
Ability to work independently, exercise independent judgment, and solve problems effectively.
Specialty coding knowledge.
One of the following credentials: CPC (Certified Professional Coder), CCS-P (Certified Coding Specialist—Physician Based), CCS (Certified Coding Specialist), or RHIT (Registered Health Information Technician).

Nice To Haves

Inpatient experience.
Epic experience.

Responsibilities

Assign or verify CPT and ICD-10-CM codes and modifiers based on documentation, ensuring compliance with official coding guidelines.
Code, review, and release charges in a timely manner and support complete, accurate charge capture and billing compliance.
Resolve charge edits according to established policies and procedures and ensure all required data elements are applied.
Monitor charge-capture volumes and work queues; serve as a resource for department leaders, administrators, clinical staff, and revenue-cycle staff.
Work with clinic staff and providers to resolve missing or unclear billing information.
Query providers as needed and coordinate responses to provider questions.
Identify coding trends and educational opportunities for providers and other staff.
Identify opportunities to reduce denials.
Develop and maintain protocols and processes for assigned areas of responsibility.
Maintain understanding of teaching physician and provider documentation policies.
May train other coders on new departments or specialties.