Professional Fee Coder III

Cleveland Clinic

1d•Remote

About The Position

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As a Professional Fee Coder III, you will be responsible for monitoring, reviewing, and accurately applying coding principles to clinical documentation received from ambulatory areas to support reimbursement, research, and regulatory compliance. In this role, you will assign appropriate diagnosis codes, CPT codes, and modifiers based on the medical record while ensuring adherence to federal coding guidelines. You will also identify and resolve billing discrepancies to ensure timely and accurate claim submission. This position supports Cleveland Clinic’s mission and vision by helping submit clean claims for the services provided, ensuring accuracy, integrity, and high-quality patient care. A caregiver in this role works remotely from 7:00 a.m. -- 3:30 p.m.

Requirements

High School Diploma / GED
Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college
Knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology
Three years of coding to include one year of complex coding experience in a health care environment and/or medical office setting
Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) by American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by American Academy of Professional Coders (AAPC)
Proficiency in coding and claims editing
Internal candidate: must currently be employed as a Professional Coder II at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of a Professional Coder II
Coding assessment relevant to the work may be required

Nice To Haves

Urology surgical coding experience

Responsibilities

Monitor, review and apply correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research and compliance.
Identify and apply diagnosis codes, cot codes and modifiers as appropriately supported by the medical record in accordance with federal regulations.
Ensure that billing discrepancies are held and corrected.
Compare and reconcile daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges and manual data entry.
Maintain records to be used for reconciliation and charge follow up.
Investigate and resolve charge errors.
Meet coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
Manage professional held claims within the CCF claims processing system.
Review, abstract and process services from surgical operative report.
Review, communicate and process physician attestation forms.
Communicate with physicians and other CCF departments (co-surgery) to resolve documentation discrepancies.
Assist with Evaluation and Management (E&M) audits and other reimbursement reviews.
Review and resolve E&M denials within the denial database.
Capture appropriate charges in accordance with CMS billing rules and regulations.