Profee Medical Coder Vacancies at R1 RCM PHILIPPINES, INC.

Job Info

Position Overview:

The Profee Coder plays a crucial role in the healthcare industry by accurately assigning diagnostic and procedural codes to physician services. These codes are used for billing purposes, reimbursement, and maintaining accurate medical records. The Profee Coder ensures compliance with coding guidelines, regulations, and documentation requirements while maximizing revenue and minimizing coding errors. They work closely with healthcare providers, billing teams, and administrative staff to review medical documentation and assign appropriate codes.

Responsibilities

1. Code Assignment: Review and analyze medical documentation, including patient encounters, operative reports, and clinical notes, to accurately assign diagnostic and procedural codes according to coding guidelines, such as ICD-10-CM, CPT, and HCPCS.

2. Compliance: Ensure compliance with coding guidelines, regulations, and payer-specific policies, including but not limited to Medicare and Medicaid rules, local coverage determinations (LCDs), and National Correct Coding Initiative (NCCI) edits.

3. Documentation Review: Collaborate with healthcare providers to clarify documentation, identify incomplete or ambiguous information, and request additional details to support accurate code assignment.

4. Quality Assurance: Perform regular audits and reviews to identify coding errors, discrepancies, and areas for improvement, ensuring coding accuracy, completeness, and adherence to coding guidelines.

5. Reimbursement Optimization: Maximize reimbursement by assigning appropriate Evaluation and Management (E&M) levels, modifiers, and other codes based on the complexity and specificity of the documented services.

6. Coding Systems and Software: Utilize coding software, encoders, and other tools effectively to assist in accurate and efficient code assignment. Stay updated on coding system changes and software updates. 

7. Coding Education and Training: Stay abreast of changes in coding regulations, guidelines, and industry trends through continuous education, training, and participation in professional development activities.

8. Collaboration: Collaborate with billing teams, healthcare providers, and administrative staff to address coding-related issues, resolve coding denials, and provide coding expertise and support.

9. Documentation Improvement: Identify opportunities for documentation improvement and provide feedback to healthcare providers to ensure accurate and complete documentation that supports optimal code assignment.

10. Reporting and Analytics: Generate reports and provide coding-related analytics, including coding productivity, accuracy rates, and coding-related denials, to support operational and financial decision-making.

Requirements:

1. Education and Certification: Bachelor’s degree in healthcare administration, nursing, or a related field (medical allied courses). Advanced degrees or certifications may be preferred. Certification as a Certified Professional Coder (CPC) or similar coding certification (e.g., CCS-P, CCS) is highly preferred. Education:

2. Coding Knowledge: In-depth knowledge of ICD-10-CM, CPT, HCPCS, and other coding systems, including coding guidelines, conventions, and modifier usage.

3. Medical Terminology: Strong understanding of medical terminology, anatomy, physiology, and disease processes to accurately assign codes and interpret medical documentation.

4. Coding Experience: Previous experience in professional fee coding in a healthcare setting, including familiarity with Evaluation and Management (E&M) coding and surgical coding.

5. Compliance: Thorough knowledge of coding regulations, guidelines, and industry standards, including CMS guidelines and payer-specific policies.

6. Analytical Skills: Strong analytical and problem-solving skills to review and interpret complex medical documentation, identify discrepancies, and ensure accurate code assignment.

7. Attention to Detail: Keen attention to detail to identify and resolve coding-related issues and ensure accuracy and completeness in code assignments.

8. Communication: Excellent written and verbal communication skills to collaborate with healthcare providers, billing teams, and administrative staff effectively.

9. Computer Skills: Proficient in using coding software, encoders, and electronic health record (EHR) systems. Familiarity with healthcare billing and practice management software is a plus.

10. Continuous Learning: Commitment to continuous learning and staying updated on coding changes, and regulations. 

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Company Description

Company Info

• Industry: Call Center/IT-Enabled Services/BPO
• Average Processing Time: 17 days
• Specific Location: Bonifacio Global City