Profee Coding Quality Specialist

JOB SUMMARY:

This is a REMOTE position. Applicants must reside in the United States.

• Perform complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant.
• Analyze audit findings to identify potential root causes of coding errors and prevent their reoccurrence.
• Provide second-level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
• Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Provide technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third-party payer requirements, medical necessity requirements.
• Protect privacy and confidentiality of patient health and client information.
• Follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines and compliance practices.
• Suggest physician query opportunities and query physicians based on documentation and clinical needs.
• Prepare deliverables for coders as required; report work time and work production in a timely and accurate manner.
• Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.
• Provide schedule of planned work activities, events and sites, and any changes to management and appropriate staff.
• Maintain professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education.
• Monitor ongoing progress and success of each coder and maintain QA percentages within two internal quality goals: overall minimum coder accuracy of 95% and QA review percentages as close to 10% as possible.
• Identify and resolve coding quality problems or issues in a timely manner; maintain continual knowledge of problems that could affect coding quality levels.
• Assist in design of systems to improve coder productivity and accuracy.
• Provide monthly reports, participate in corporate training and meetings, and provide status reports to senior manager as requested.
• Align conduct with AHIMA's Standards of Ethical Coding, the Company’s Code of Ethics and Business Conduct, and support the Company’s Ethics and Compliance Program.
• Interpret coding guidelines for accurate code assignment; identify importance of documentation on code assignment and reimbursement impact.
• Comply with all internal policies and procedures, and actively participate in company-provided training and education.
• Ensure individual compliance with all privacy and security rules and regulations, and protect all confidential information, including Personal Health Information.

• Regular, predictable and punctual attendance required.
• Strong verbal and written communication skills.
• Ability to prioritize workload, meet deadlines, and maintain a high level of quality and accuracy.
• Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered.
• Minimum 3 years of Profee coding experience and/or auditing in an acute care facility or multispecialty clinics.
• Minimum one-year customer service support experience.
• Familiarity with hospital outpatient billing processes and understanding of APC assignment, coding, and documentation.
• Proficiency in Microsoft Office (Word, Excel).
• Strong analytical skills; ability to work with multiple and diverse clients and projects.
• Strong team player, capable of working with minimal supervision and telecommuting; experience with electronic medical records systems strongly preferred.
• Coding certification preferred (CPC or CCS).
• Pro Fee multi-specialty experience required; OP facility experience preferred.

• Regular eye–hand coordination and manual dexterity required to operate office equipment.
• Ability to work at a computer terminal for 6–8 hours a day in a frequently interrupted environment.
• Ability to sit for prolonged periods; occasional lifting of material up to 20 lbs.
• Ability to manage elevated stress during periods of increased activity and with multiple deadlines.