Job Summary
The Remote Physician Pro Fee Coding Specialist- Denials (OBGYN) 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.
Essential Functions
Assigns accurate CPT, HCPCS, and ICD-10 codes for professional services,
procedures, diagnoses, and treatments based on provider documentation.
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).
Performs coding audits and quality reviews, verifying accuracy of
documentation and identifying areas for provider education.
Works coding-related claim edits, holds, and scrubs in the electronic billing
system (e.g., Athena Collector), ensuring timely claim resolution and
reimbursement.
Collaborates with physicians, revenue cycle teams, and coding education
staff, requesting clarification when necessary to ensure optimal
documentation and compliance.
Performs edit checks on coded data before transmittal, identifying and
correcting errors as needed.
Maintains strict confidentiality of patient records, provider information,
and financial data, adhering to HIPAA and corporate compliance policies.
Escalates documentation or coding issues to the coding education team for
provider training and improved documentation practices.
Assists in coding-related special projects, ensuring accurate reporting and
analysis of coding data for operational improvement.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.
Qualifications
H.S. Diploma or GED required
Associate Degree in Health Information Management, Healthcare Administration,
or a related field preferred
2-4 years of experience in physician coding, professional fee coding, or
medical billing required
Experience with multiple specialties, surgical coding, or high-volume
professional fee coding preferred
Knowledge, Skills and Abilities
Strong knowledge of ICD-10, CPT, and HCPCS coding systems for
physician/professional fee services.
Understanding of modifier usage, place-of-service coding, and payer billing
guidelines.
Experience with electronic health records (EHR), coding software, and claim
processing systems.
Ability to identify documentation deficiencies and escalate for provider
education.
Familiarity with NCCI edits, LCD/NCD guidelines, and medical necessity
requirements.
Strong analytical and problem-solving skills, ensuring accurate coding and
optimal reimbursement.
Effective communication and collaboration skills, working with providers,
revenue cycle teams, and compliance staff.
Licenses and Certifications
CCS-Certified Coding Specialist (CCS-P) required or
Certified Coder-AHIMA or AAPC or equivalent coding certification required or
RHIT - Registered Health Information Technician required or
RHIA - Registered Health Information Administrator required