Profee Coding Quality Specialist

About the Company

We are dedicated to aiding clients in surpassing their financial health objectives through comprehensive reimbursement cycle solutions and clinical expertise. Utilizing advanced technology and analytics enables us to deliver accountable and effective outcomes. We are committed to fostering long-term career growth by investing in our team members' professional and personal development, believing that their success directly reflects our own.

Job Overview

This role is fully remote and requires residency within the United States.

Key Responsibilities

• Carry out detailed retrospective reviews of medical record documentation to detect coding and billing mistakes and inconsistencies in compliance with guidelines from authoritative bodies such as AHA, CMS, AMA, Clinic Coding Clinic, and CPT Assistant.
• Analyze audit results to determine root causes of coding errors and establish preventive measures.
• Conduct secondary reviews of diagnosis, procedure, and billing codes ensuring adherence to legal and procedural standards that facilitate optimal reimbursements while preventing unbundling or other questionable practices.
• Investigate and respond to queries related to compliance issues, incorrect coding, claim denials, and billable services.
• Offer technical assistance and training feedback to internal coding teams on compliance, documentation standards, regulatory mandates, third-party payer requirements, and medical necessity criteria.
• Protect patient and client information confidentiality and privacy.
• Adhere strictly to the ethical coding standards as stipulated by AHIMA and maintain compliance with official coding guidelines and practices.
• Identify opportunities for physician queries based on documentation and clinical requirements.
• Prepare necessary deliverables for coders, accurately report work time and output, and communicate with colleagues in a respectful, open manner fostering teamwork and knowledge sharing.
• Inform management and relevant staff about planned work activities, events, and any changes thereof.
• Continually maintain professional coding credentials and stay informed about coding, reimbursement strategies, and compliance topics via ongoing education.
• Monitor coder performance ensuring quality assurance goals are met, including maintaining coder accuracy at a minimum of 95% and quality reviews close to 10%.
• Identify and address coding quality issues promptly and maintain awareness of factors influencing coding quality levels.
• Contribute to designing systems aimed at enhancing coder productivity and accuracy.
• Compile monthly performance reports and participate actively in corporate trainings and meetings.
• Provide status updates to senior management as needed and uphold both AHIMA's ethical coding standards and the company's Code of Ethics and Business Conduct.
• Interpret coding guidelines accurately to ensure correct code assignments and recognize the reimbursement impact of documentation quality.
• Strictly comply with all company policies, privacy, and security regulations, including the protection of confidential and personal health information.
• Demonstrate proficiency with ProFee multi-specialty coding; experience with outpatient facility coding is preferred.

Qualifications and Requirements

• Consistent, reliable, and punctual attendance is essential.
• Strong verbal and written communication capabilities are mandatory.
• Ability to effectively prioritize tasks, meet deadlines, and maintain high levels of accuracy and quality.
• Must hold a recognized coding credential from AHIMA or AAPC; RHIA or RHIT credentials may also be considered.
• Telecommuting experience and familiarity with electronic medical record systems are strongly preferred.
• Advanced analytical skills and excellent written communication.
• Ability to collaborate effectively within a team environment and manage multiple diverse projects and clients.
• Able to work independently with minimal oversight.
• A minimum of three years' experience in ProFee coding and/or auditing within acute care facilities or multispecialty clinics.
• Initiative, resourcefulness, and meticulous attention to detail.
• At least one year of customer service experience.
• Knowledge of hospital outpatient billing procedures and an understanding of hospital APC assignment and relevant coding/documentation.
• Coding certifications such as CPC or CCS are preferred.
• Strong proficiency in Microsoft Office programs including Word and Excel.
• Competent in navigating various EMR systems and reviewing handwritten medical records.

Physical and Work Environment

Reasonable accommodations may be provided for individuals with disabilities to perform essential job functions. The role requires prolonged periods of computer use, manual dexterity for office equipment, and the ability to sit for extended durations. Occasionally, lifting up to 20 pounds may be necessary. The work environment can be subject to interruptions and elevated stress during periods of increased activity and tight deadlines.

Additional Information

This job description serves as a guideline encompassing core duties and responsibilities but is not exhaustive. Supervisors may assign additional duties as required.