PF Concepts

Description Required: 5+ years of experience in inpatient coding auditing or compliance Location: Remote Job Summary: The Inpatient Coding Auditor is responsible for auditing inpatient coding and DRG assignment to ensure accurate ICD-10-CM/PCS coding, documentation support, and compliance with official guidelines and payer requirements. This role tracks audit outcomes, supports corrective actions, and provides education to improve coding quality and reduce audit risk. Responsibilities include, but are not limited to: - Review entire medical record to confirm correct assignment of ICD-10-CM/PCS coding, sequencing and POA to ensure proper assignment of MS-DRG/APR-DRG. - Review clinical documentation for guideline compliance, clinical support, and accurate capture of CC/MCC and key secondary diagnoses and procedures. - Identify trends, root causes, and compliance risks; recommend corrective actions and process improvements in collaboration with coding leadership and CDI. - Work closely with leadership create and prepare detailed audit reports, including findings, financial impact considerations, and error-rate metrics; track follow-up actions and re-audit results. - Provide education and feedback to inpatient coders and CDI partners; develop reference tools and training materials. - Support external audits and payer requests (e.g., RAC/DRG audits) and assist with appeal support when needed. - Stay current with CMS IPPS changes, Coding Clinic guidance, official coding guidelines, and payer policy updates. - Ensure accurate abstraction of data elements impacting reimbursement and reporting (e.g., discharge disposition, admission source, procedure dates). - Maintain audit tools, policies, and procedures; assist with continuous improvement initiatives. - Maintain established productivity standards by PF Concepts or client - Maintain HIPAA compliance and protect patient confidentiality in all work activities. Compensation: - $40.00–$44.00 per hour, depending on experience. Schedule: - Per diem / as needed; no guaranteed minimum hours. Requirements Qualifications: - Bachelor’s Degree or Associate's Degree in Health Information Management or related field; bachelor's degree preferred - Credentials from AHIMA or AAPC, AHIMA preferred, AAPC considered with facility coding experience. - 5+ years of recent inpatient acute-care coding experience with auditing/DRG validation experience preferred. - Expert knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGs, POA, CC/MCC capture, and official coding guidelines/Coding Clinic. - Strong analytical skills and ability to interpret clinical documentation and support audit conclusions. - Ability to prepare detailed written reports and communicate findings effectively. - Proficiency with EHR and encoder/coding tools and Microsoft Excel/Office. - Effective communication and coaching skills to deliver coder education and corrective action follow-up. - Active coding certification required (CCS or CIC); RHIT/RHIA and CDIP are a plus. - Proficiency with multiple applications: Oracle, Epic, Meditech, Powerchart, Soarian Financials, Clintegrity, Solventum 360, etc

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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