ProFee Coding Specialist III

Children's Hospital and Health System•West Allis, WI

1d•Remote

About The Position

The ProFee Coding Specialist III collaborates with ancillary or specialty departments, locations, and providers to code, review, and release charges promptly, ensuring correct coding, billing compliance, and complete charge capture. The specialist works with providers and departmental staff and leaders on coding- and charge-capture-related questions and topics. This is a 100% remote, full-time position, Monday through Friday, for 40 hours per week. The role assigns or verifies CPT and ICD-10-CM coding and modifiers based on documentation, and serves as a subject matter expert in one or more specialties. The specialist may cover multiple surgical or medical specialties for abstraction, ambulatory coding, and/or surgical and procedural coding. The role also resolves charge edits, monitors charge-capture volumes and work queues, supports consistent and accurate charge capture, and identifies coding trends, educational opportunities, and ways to reduce denials. The specialist maintains protocols and processes for assigned areas and may train other coders on new departments or specialties.

Requirements

At least three years of experience coding Pro-Fee E/M services for multiple specialties.
High school graduate, GED, or High School Equivalency Diploma (HSED).
One of the following certifications: CPC (Certified Professional Coder) from the American Board of Professional Coders; CCS-P (Certified Coding Specialist Physician Based) from the American Health Information Management Association; CCS (Certified Coding Specialist) from the American Health Information Management Association; or RHIT (Registered Health Information Technician) from the American Health Information Management Association.
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.

Nice To Haves

Inpatient experience.
Experience coding bedside procedures in an inpatient setting.
Experience working claim edits and denials.
Epic experience.

Responsibilities

Assign or verify CPT, ICD-10-CM coding, and modifiers based on documentation.
Serve as a subject matter expert in one or more specialties and potentially cover multiple surgical or medical specialties for abstraction, ambulatory, and/or surgical or procedural coding.
Ensure compliance with official coding guidelines.
Resolve edits for charges in accordance with established policies and procedures, ensuring all data elements are applied.
Monitor charge-capture volumes and work queues, and serve as a resource for department leaders, administrators, clinical staff, and revenue-cycle staff to support consistent and accurate charge capture.
Work with clinic staff and providers to address missing or unclear billing information.
Query providers as needed and coordinate responses to provider questions.
Use coding knowledge to identify 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.
Collaborate with ancillary or specialty departments, locations, providers, and departmental staff and leaders on coding, charge review, charge release, billing compliance, charge capture, and related questions.