Profee Coding Quality Specialist

📋 Description

• • Perform complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies in accordance with AHA, CMS, AMA, Clinic Coding Clinic, and CPT Assistant guidelines.
• • Conduct second-level review of diagnosis, procedure, and billing codes to ensure compliance with legal and procedural policies that optimize reimbursements while preventing unbundling and other non-compliant practices.
• • Research, analyze, and respond to inquiries regarding compliance violations, inappropriate coding, claim denials, and billable services.
• • Provide technical support and feedback training to internal coding staff on coding compliance, documentation standards, regulatory requirements, third-party payer rules, and medical necessity criteria.
• • Protect patient health information and client data by adhering to privacy and confidentiality standards and complying with all HIPAA and company security policies.
• • Follow AHIMA’s Standards of Ethical Coding and the company’s Code of Ethics and Business Conduct in all professional activities.
• • Identify and suggest physician query opportunities based on clinical documentation gaps to improve code accuracy and reimbursement.
• • Prepare and deliver coded data reports and deliverables to coding teams as required.
• • Accurately report work time and production metrics in a timely manner to ensure operational accountability.
• • Maintain QA accuracy targets: achieve a minimum coder accuracy rate of 95% and aim for QA review rates as close to 10% as possible.
• • Identify, analyze, and resolve coding quality issues promptly to prevent recurrence and improve overall coding integrity.
• • Assist in designing systems and processes to enhance coder productivity and coding accuracy.
• • Generate monthly quality and performance reports for management review.
• • Participate in corporate training sessions, compliance meetings, and professional development activities.
• • Provide regular status updates to senior managers upon request.
• • Maintain active professional coding credentials and stay current on coding guidelines, reimbursement methodologies, and regulatory changes.
• • Monitor individual coder performance and progress to ensure alignment with quality benchmarks.
• • Interpret complex coding guidelines to ensure accurate code assignment and understand the direct impact of documentation on reimbursement outcomes.
• • Comply with all internal policies, procedures, and privacy regulations, including protection of Personal Health Information (PHI).
• • Navigate multiple EMR environments and review handwritten medical charts to validate coding accuracy.
• • Work with multiple and diverse clients and projects across ProFee multi-specialty settings, with OP facility experience preferred.
• • Demonstrate strong teamwork, open communication, and respectful collaboration with coworkers to foster knowledge sharing and a positive work environment.
• • Operate effectively with minimal supervision while maintaining high standards of accuracy, quality, and deadline adherence.