Profee Coding Auditor

6 days ago


Oak Park, Illinois, United States LaSalle Network Full time
Profee Coding Auditor Job Description

LaSalle Network is seeking a skilled Profee Coding Auditor to join our team. As a Profee Coding Auditor, you will be responsible for performing regular audits of professional fee (profee) coding and provider documentation.

Key Responsibilities:
  • Conduct thorough audits of profee coding and provider documentation to ensure accuracy and completeness.
  • Verify the accuracy and completeness of ICD-9-CM, ICD-10-CM, CPT-4, and HCPCS coding, including modifiers, units, and other variables.
  • Ensure providers accurately capture services rendered to patients and assess compliance with Medicare, Medicaid, and other third-party payer requirements.
  • Re-code encounters from source documentation when errors are identified, complete supporting worksheets documenting the rationale for coding decisions.
  • Compare audit findings against provider-generated codes, identifying and recording discrepancies and the logic for changes in coding decisions.
  • Provide specialty-specific training to clinicians on documentation of services and appropriate coding of E/M, diagnosis (ICD-9 and ICD-10), and procedures (CPT and HCPCS).
  • Prepare detailed audit reports and present findings to providers and management.
  • Collaborate with coding and billing teams to address and resolve coding issues.
Requirements:
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification through AHIMA and/or AAPC is required.
  • Expertise in E&M coding is essential.
  • 3+ years of professional coding experience, with at least 2 years in an auditing role preferred.
  • Strong knowledge of ICD-9-CM, ICD-10-CM, CPT-4, and HCPCS coding systems.
  • Experience with Medicare, Medicaid, and third-party payer coding and billing requirements.
  • Excellent presentation and training skills.
  • Strong attention to detail and organizational skills.
  • Strong analytical and problem-solving abilities.
  • Effective communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Proficiency in using healthcare coding software and electronic health records (EHR) systems.

LaSalle Network is an Equal Opportunity Employer m/f/d/v.

LaSalle Network is the leading provider of direct hire and temporary staffing services. For over two decades, LaSalle has helped organizations hire faster and connect top talent with opportunities, from entry-level positions to the C-suite.


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