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Role Description

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.

• 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.

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.

Requirements

• 3-5 years of experience in professional (profee) medical coding auditing or compliance.

Company Description