Posted Apr 16

Professional Fee Hospital Coder - Remote

United States of America Full Time


The Professional Fee Coder is responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation for hospital services.

Working from the appropriate documentation in the medical record, assigns codes and modifiers with ICD-10-CM, CPT and HCPCS Level II codes when appropriate.

***These are Full Time Hourly Rate Positions ***

A Professional Services Coder assigns Pro-fee codes in the following settings:
• Hospital, Emergency Department (ED),
• Hospital Observation (HOPS),
• Hospital Ambulatory (HAS),
• Hospital Outpatient (HOV) and Medical Office.


1. Review Medical Records to resolve Ingenix Coding Edits
• Identify and resolve coding related edits by reviewing the medical record and ensuring that all data and codes are consistent with ICD-10-CM Official Guidelines, CPT, CPT Assistant, CMS, OMFS, MediCal,
• Correct data as appropriate

2. Review Medical Records to identify diagnoses/procedures
• Code all diagnostic and operative information from the medical record using ICD-10-CM, CPT and HCPCS coding classification systems
• Verifies and abstracts all medical data from the record to assign appropriate codes for the following settings:
o Inpatient Hospital (IP), Hospital Emergency (ED), Hospital Observation (HOPS), Hospital Ambulatory (HAS), Hospital Outpatient (HOV) and Medial Office
o Corrects data as appropriate

3. Work Organization and Prioritization
• Organizes and prioritizes all work to ensure that records are coded, and edits are resolved, in a time frame that will assure compliance with regulatory, billing requirements.

4. Completeness of Medical Record Data
• Under general supervision, interacts with clinical contacts to clarify and promote accurate documentation of patient diagnostic and procedural information
• Enters patient information into the computerized medical record and billing systems, ensuring the accuracy and integrity of the medical record data abstracted or encounter data corrected, prior to submitting the data
• Ensures timely data completion by meeting coding/abstracting productivity/quality standards established for the Pro-Fee Coder.
• • Provides feedback to monitor service provider and line of business compliance with regulatory requirements

5. Other Duties
• Answers the telephone promptly and identifies themselves and the department
• Acts as a resource person to other departments regarding coding questions and issues
• Other duties as assigned by Lead Coders and Managers

Job Requirements:

Work Experience

Minimum of two, of the last three years, continuous professional coding/abstracting experience and Passing grade on Aviacode Pro-fee test.

Functional/Technical Knowledge & Skills
• Must be able to meet production and quality standards.
*Demonstrated knowledge of Anatomy and Physiology, medical terminology, disease processes.
• Basic knowledge of reimbursement methodologies and conventions
• Knowledge of rules and guidelines for current coding classifications
• Demonstrated ability to understand the clinical contents of a health record
• Demonstrated ability to communicate with physicians in order to clarify diagnoses and procedures coding and documentation requirements, including proper sequencing
• Must maintain current coding credential and perform associated Continuing Education Units Industry

• Working knowledge of hospital and/or physician clinic based revenue cycle
• Working knowledge of professional services coding and billing in a multi-specialty environment
• Working knowledge of government and other payer coding, billing and collection rules and regulations.

• Completion of classes in medical terminology, anatomy and physiology, ICD-10-CM, CPT and HCPCS coding conventions, and disease process from and accredited program is required.
• Must have High School diploma or GED.
• License/Certification
o Current certification as a Certified Professional Coder (CPC) or Certified Coding Specialist for Professional Services (CCS-P)

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