Profee QA Lead, Coding Solutions

Position Title: Profee QA Lead, Coding Solutions

Location: Remote/Tampa

Compensation: $85k-115K

Benefits: Medical, dental, and vision coverage for employees and dependents; 401(k) eligibility

As part of Harmony’s centralized Coding Solutions team, the Lead – ProFee role will: help ensure quality coding across professional fee coding consultants in production, assist with identifying, developing, and presenting relevant coding education to Harmony coding consultants, and lead professional fee coding projects. These three business objectives will support coding quality, client satisfaction and employee development and retention.

Travel: Not expected – less than 10% if applicable

Responsibilities:

• Conducts audits of professional fee/billing coding to validate the integrity of ICD-10-CM diagnoses, CPT, HCPCS, modifiers, charges, and/or professional Evaluation and Management (E/M) codes assigned for all specialties and chart types

• Validates assigned codes, modifiers and charges for accuracy based on medical record documentation and established ICD-10-CM, CPT-4 coding guidelines and CPT Assist articles • Analyzes audit results to identify patterns and trends• Documents audit findings with clarity and calculates billing error rates• Provides feedback and education as appropriate depending on findings• Identifies coding/charging opportunity trends across projects for education content• Prepares and delivers coding education materials• Works with management to fulfill requests for education during monthly quality audits, as issues are found• Leads billable professional fee coding projects• Conducts ad hoc coding and billing audits as requested• Serves as subject matter expert on appropriate coding and documentation standards, guidelines, and regulatory requirements• Serves as subject matter expert on interviews • Ability to prioritize multiple assignments and multiple spreadsheets, documents and reports• Manages time efficiently and follow through on duties to completion• Assi sts with other tasks as assigned by management

2

Experience

Requirements

• 5 years of professional fee/billing coding experience, including ICD-10 –

CM, E/M leveling, and CPT procedure coding

• 3 years of quality assurance auditing experience

• Certified Coding Specialist-Physician-based (CCS-P) or Certified

Professional Coder (CPC)

• Registered Health Information Administrator (RHIA) or Registered Health

Information Technician (RHIT)

• Proficiency with various documentation and Electronic Health Records

(EHRs)

• Extensive experience in all professional fee/billing types including inpatient,

outpatient surgery, observation, emergency department and ancillary services

• Expert knowledge of NCCI/OCE billing edits as it relates professional

services coding and billing

• Industry knowledge of reimbursement methodology, federal, state and payor

coding, documentation and billing requirements

• Proficient in computer applications such as Microsoft Excel, Teams,

PowerPoint, Word, and Outlook

• Thorough knowledge of E/M Guidelines for Professional Services and

facility E/M codes

• Excellent communication and interpersonal skills, oral and written