Profee Coding Auditor

2 days ago


Oak Park, Illinois, United States The LaSalle Group 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:
  • Perform regular 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.


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