Professional Fee Coder at PF Concepts

Fairfield, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Jun, 26

Salary

0.0

Posted On

11 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Coding Auditing, ICD-10-CM, CPT, HCPCS, Modifiers, E/M Coding, NCCI Edits, Payer Guidelines, Provider Querying, Productivity Management, Revenue Cycle, HIPAA Compliance, EHR Proficiency, Encoder Tools, Analytical Skills, Communication

Industry

Wholesale

Description

Description Required: 3-5 years of experience in professional (profee) medical coding auditing or compliance Location: Remote Job Summary: The Professional Fee Coder (ProFee) is responsible for reviewing provider documentation and assigning accurate ICD-10-CM, CPT, and HCPCS codes for physician professional services. This role supports compliant coding, timely charge capture, and clean claim submission in accordance with AMA, CMS, and payer guidelines. Responsibilities include, but are not limited to: Review provider documentation and assign ICD-10-CM, CPT, HCPCS Level II codes, and applicable modifiers for professional fee services. Select appropriate Evaluation and Management (E/M) levels based on current guidelines (MDM and/or time and ensure documentation supports code selection. Apply modifier and global surgery rules accurately (e.g., 25, 24, 57, 58, 59, 78, 79) and comply with NCCI edits and payer policies. Ensure medical necessity and proper linkage of diagnoses to services; identify and resolve coding edits prior to claim submission when applicable. Query providers for clarification when documentation is incomplete or ambiguous, following compliant query practices. Meet established productivity, accuracy, and turnaround time standards to support billing and revenue cycle goals. Collaborate with billing/denials teams to resolve coding-related rejections and provide supporting rationale for appeals as needed. Maintain confidentiality and comply with HIPAA and organizational policies when handling protected health information. Stay current with coding guideline updates, payer changes, and compliance requirements; complete required continuing education. Participate in internal quality reviews and implement corrective actions to improve coding accuracy. Requirements Qualifications 3+ years of recent professional fee (physician) coding experience; multi-specialty experience preferred. Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, NCCI edits, and payer guidelines. Experience applying current E/M coding guidelines and common professional fee compliance requirements. Proficiency with EHR and encoder/coding tools (e.g., Epic, Cerner, 3M, Optum) and Microsoft Office. Excellent attention to detail, analytical skills, and ability to manage multiple priorities. Effective communication skills for provider/coder collaboration and documentation clarification. Active coding certification required (CPC or CCS/CCA); CPMA or specialty credential is a plus. Must be credentialed from AAPC or AHIMA, AAPC preferred.

Responsibilities

The Professional Fee Coder reviews provider documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes for physician services, ensuring compliant coding and timely charge capture. This role involves applying complex coding rules, querying providers when documentation is unclear, and collaborating with billing teams to resolve claim issues.