Professional Fee Auditor

Job Description

Job Description

Description :

JOB SUMMARY : The Medical Coding Specialist, Professional Fee is responsible for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, Evaluation and Management Guidelines, and CMS directives. Performs data entry of required abstracted patient information into the client’s information system. Queries physicians when appropriate and interacts with Clinical Documentation staff as per account requirements. Maintains consistent coding accuracy rate of 95% or better while also meeting productivity standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Assign appropriate ICD-10-CM, E / M, CPT, HCPCS codes and modifiers to professional fee accounts as per designated workflow. Evaluation and management as well as surgical procedures may be assigned
• Abstract and enter coded data and / or charges for physician statistical and reporting requirements
• May assign / validate professional fee level of service based upon appropriate guidelines based upon place of service and date of service
• Query physicians to clarify conflicting, imprecise, incomplete, ambiguous, and / or inconsistent clinical information when appropriate
• Communicate documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution
• Communicate with Clinical Documentation Improvement and / or Revenue Cycle teams for follow up and reconciliation of accounts
• Maintain required productivity and quality requirements
• Maintain coding credential requirements

BENEFITS :

We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short / long term disability insurance, and PTO policy.

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS :

Sitting, talking, hearing and near vision are required over 90% of the time. Feeling is required over 90% of the time and reaching is required about 50% of the time. The ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS :

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Requirements :

REQUIRED QUALIFICATIONS :

KEY SUCCESS ATTRIBUTES :

CORE COMPETENCIES :