Remote Physician Profee Coding Specialist - NICU and Hospital Medicine ICU at Community Health Systems Professional Services Corporation

United States

<p><strong>Job Summary</strong><br><br>The Remote Physician Pro Fee Coding Specialist-NICU and Hospital Medicine ICU is responsible for reviewing, analyzing, and assigning accurate CPT, HCPCS, and ICD-10 codes for professional fee services documented in the medical record. This role ensures proper sequencing, modifier use, and place-of-service coding in compliance with governmental regulations, third-party payer policies, and corporate standards. The Physician Coder plays a key role in revenue cycle accuracy by identifying documentation gaps, ensuring coding integrity, and working collaboratively with internal teams to support physician coding compliance and reimbursement.<br><br><strong>Essential Functions</strong></p><ul><li>Assigns accurate CPT, HCPCS, and ICD-10 codes for professional services, procedures, diagnoses, and treatments based on provider documentation.</li><li>Ensures compliance with governmental regulations, third-party payer policies, and corporate coding protocols, following National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs).</li><li>Performs coding audits and quality reviews, verifying accuracy of documentation and identifying areas for provider education.</li><li>Works coding-related claim edits, holds, and scrubs in the electronic billing system (e.g., Athena Collector), ensuring timely claim resolution and reimbursement.</li><li>Collaborates with physicians, revenue cycle teams, and coding education staff, requesting clarification when necessary to ensure optimal documentation and compliance.</li><li>Performs edit checks on coded data before transmittal, identifying and correcting errors as needed.</li><li>Maintains strict confidentiality of patient records, provider information, and financial data, adhering to HIPAA and corporate compliance policies.</li><li>Escalates documentation or coding issues to the coding education team for provider training and improved documentation practices.</li><li>Assists in coding-related special projects, ensuring accurate reporting and analysis of coding data for operational improvement.</li><li>Performs other duties as assigned.</li><li>Maintains regular and reliable attendance.</li><li>Complies with all policies and standards.</li></ul><p><strong>Qualifications</strong></p><ul><li>H.S. Diploma or GED required</li><li>Associate Degree in Health Information Management, Healthcare Administration, or a related field preferred</li><li>2-4 years of experience in physician coding, professional fee coding, or medical billing required</li><li>Experience with multiple specialties, surgical coding, or high-volume professional fee coding preferred</li></ul><p><strong>Knowledge, Skills and Abilities</strong></p><ul><li>Strong knowledge of ICD-10, CPT, and HCPCS coding systems for physician/professional fee services.</li><li>Understanding of modifier usage, place-of-service coding, and payer billing guidelines.</li><li>Experience with electronic health records (EHR), coding software, and claim processing systems.</li><li>Ability to identify documentation deficiencies and escalate for provider education.</li><li>Familiarity with NCCI edits, LCD/NCD guidelines, and medical necessity requirements.</li><li>Strong analytical and problem-solving skills, ensuring accurate coding and optimal reimbursement.</li><li>Effective communication and collaboration skills, working with providers, revenue cycle teams, and compliance staff.</li></ul><p><strong>Licenses and Certifications</strong></p><ul><li>Certified Coder-AHIMA or AAPC (CPC) required or</li><li>CCS-Certified Coding Specialist (CCS-P) required</li><li>Additional certifications such as Certified Evaluation and Management Coder (CEMC) or Registered Health Information Technician (RHIT) preferred</li></ul>