Summary

The Senior Professional Fee Coder is responsible for ensuring accurate and timely coding of physician and professional services by assigning appropriate ICD-10-CM and CPT codes based on clinical documentation. This role reviews medical records, resolves coding edits and charge discrepancies, and helps ensure compliant claim submission to maximize reimbursement. The coder collaborates with physicians, clinical staff, and billing teams to provide coding guidance, support revenue cycle operations, and maintain compliance with coding regulations and organizational policies. Through detailed documentation review and reconciliation of charges, this position plays a key role in the financial integrity of the organization.

The Senior Professional Fee Coder serves as a subject matter expert responsible for accurate coding, charge capture, and revenue cycle support for physician professional services across multiple clinical specialties. This position ensures compliance with federal regulations, payer policies, and institutional guidelines while supporting the financial performance of the Faculty Group Practice.

Job Duties

• Assigns ICD-10-CM, CPT, and HCPCS codes to professional services.
• Reviews physician documentation, operative reports, procedure notes, clinic encounters, and ancillary reports to accurately assign diagnosis and procedure codes in accordance with current ICD-10-CM, CPT, HCPCS Level II, and payer-specific guidelines.
• Ensures coding accurately reflects the services performed and supports medical necessity while maintaining compliance with federal regulations, National Correct Coding Initiative (NCCI) edits, and Medicare guidelines.
• Codes a variety of surgical and evaluation and management (E/M) services across multiple specialties.
• Reviews and abstract medical record documentation.
• Analyzes complex medical records to ensure complete and accurate charge capture.
• Interprets operative reports and physician documentation to determine the appropriate coding and sequencing of diagnoses and procedures.
• Identifies documentation deficiencies and communicate with providers when clarification is required to support accurate coding and billing.
• Performs charge reconciliation and resolve billing edits.
• Reviews daily work queues to identify missing charges, coding edits, claim rejections, and billing exceptions prior to claim submission.
• Researches and resolves charge discrepancies using the electronic health record (Epic), Optum Claims Manager, encoder software, payer policies, and departmental billing systems.
• Ensures charges are submitted accurately and within established productivity and timeliness standards to minimize claim delays and maximize reimbursement.
• Performs other job-related duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Five years of relevant experience.
• Certified Coding Specialist – Physician-based (CCS-P) by the American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC). 

Preferred Qualifications

• Anesthesia experience.