ProFee Coder - Internal Medicine

About the role

The Professional Coder is responsible for accurately assigning ICD-10-CM, CPT, HCPCS Level II, and applicable modifiers for physician and other qualified healthcare professional services. This role ensures coding accuracy, documentation integrity, and compliance with official coding guidelines, regulatory requirements, and payer-specific policies.

The coder reviews clinical documentation to capture diagnoses, procedures, and services performed in outpatient and professional settings, supporting appropriate reimbursement, minimizing claim denials, and ensuring high-quality, compliant coding that contributes to overall revenue integrity and data accuracy.

Qualifications

• Advanced knowledge of ICD-10-CM, CPT, HCPCS Level II, and modifier assignment for physician and other qualified healthcare professional services.
• Strong understanding of professional coding guidelines, including CPT Assistant, Coding Clinic guidance, and AMA/CMS documentation standards.
• Proficiency in applying Official Coding Guidelines and payer-specific policies for outpatient and professional services.
• Knowledge of medical terminology, anatomy, physiology, pharmacology, and disease processes to support accurate code assignment.
• Ability to accurately interpret clinical documentation to assign diagnoses, procedures, and services at the professional level.
• Experience applying NCCI edits and payer-specific claim editing rules to ensure compliant coding and reduce denials.
• Understanding of medical decision-making (MDM) concepts and documentation requirements supporting professional E/M services (if applicable to role scope).
• Ability to identify coding discrepancies, documentation gaps, and claim issues impacting reimbursement and compliance.
• Ability to research coding questions using authoritative resources such as CMS guidelines, CPT Assistant, Coding Clinic, and payer policies.

Requirements

• Minimum of 2-4 years of professional (physician-based) coding experience in a multi-specialty, hospital-based physician group, or outpatient environment.
• Active certification from AHIMA or AAPC such as: CPC, CCS, RHIT.
• EPIC experience required.
• Schedule is 40 hours worked Monday - Friday between 6a - 6p Pacific time. The schedule is flexible between those hours.
• Must pass a client coding assessment with a score of 80% or higher
• Ability to maintain required CPH (charts per hour) and accuracy standards
• US based candidates only