ProFee Inpatient Coding Specialist III - REMOTE

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

1d•Remote

About The Position

Children’s Wisconsin is a nationally recognized health system dedicated to children’s health and well-being. The ProFee Inpatient Coding Specialist III works with ancillary or specialty departments, locations, and providers to code, review, and release charges promptly while ensuring accurate coding, billing compliance, and complete charge capture. The specialist collaborates with providers and departmental staff and leaders on coding and charge-capture questions. This is a 100% remote, full-time position, Monday through Friday, 40 hours per week. The role requires three years of experience coding Pro-Fee inpatient E/M services for multiple specialties. NICU experience is preferred. Experience coding inpatient bedside procedures and working claim edits and denials is also sought. Epic experience is preferred. The specialist assigns or verifies CPT and ICD-10-CM codes and modifiers based on documentation, ensures compliance with official coding guidelines, and resolves charge edits according to established procedures. The role may serve as a subject matter expert in one or more specialties and may cover multiple surgical or medical specialties. It also supports charge-capture monitoring, works with providers and clinic staff to clarify billing documentation, identifies coding trends and educational opportunities, and helps reduce denials. The specialist maintains protocols and processes for assigned areas, understands teaching physician and provider documentation policies, and may train other coders on new departments or specialties. A high school diploma, GED, or HSED is required, along with one of the listed coding or health information credentials: CPC, CCS-P, CCS, or RHIT. Children’s Wisconsin is an equal opportunity employer committed to a diverse and inclusive environment.

Requirements

Three years of experience coding Pro-Fee inpatient E/M services for multiple specialties.
Experience coding bedside procedures in the inpatient setting.
Experience working claim edits and denials.
High school graduate, GED, or HSED.
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).
Knowledge of ICD-10, CPT, and HCPCS coding guidelines.
Working knowledge of CCI edits, healthcare insurance guidelines, and other regulatory guidance.
Prior use of an electronic health record.
Excellent oral and written communication skills.
Ability to work independently, exercise independent judgment, and solve problems effectively.
Specialty coding knowledge.

Nice To Haves

NICU experience.
Epic experience.

Responsibilities

Code, review, and release charges in a timely manner to support accurate coding, billing compliance, and complete charge capture.
Assign or verify CPT, ICD-10-CM codes, and modifiers based on documentation.
Ensure compliance with official coding guidelines.
Resolve charge edits according to established policies and procedures, ensuring all data elements are applied.
Monitor charge-capture volumes and work queues, and serve as a resource to department leaders, administrators, clinical staff, and revenue-cycle staff.
Work with clinic staff and providers to address missing or unclear information required for billing.
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.
Collaborate with ancillary or specialty departments, locations, providers, and departmental staff on coding and charge-capture questions.