Professional Coding Specialist II

Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment.

General Description

Independently performs complex professional coding across multiple specialties and settings, including office/clinic, hospital outpatient, ED/urgent care, ASC, SNF/nursing home, and telehealth.Appliesadvanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement,wRVUintegrity, and audit defensibility in an academic and research enterprise.

Essential Job Duties

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position.

• Code complex professional encounters and procedures; ensure correct sequencing, modifiers, E/M levelselection, and documentation alignment.Advanced expertise in ICD10CM, CPT, HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation.

• Resolve coding-related edits and denials byidentifyingroot cause, coordinating documentation clarification, and supporting rebilling actions as applicable.

• Apply payer medical policies, NCCI concepts, global service considerations, and telehealth coding rules as relevant to pro fee claims.

• Providerealtime guidance to peers on standard coding scenarios; promote consistency through bestpractice sharing.

• Participate in internal quality review programs and implement education/corrective actions based on findings.

• Proficiencyin Epic professional codingwork queuesand encoder tools; ability to efficiently review documentation in the EHR across settings.

• Analytical problem solving for denial/edits prevention; ability toidentifydocumentation improvement opportunities and support compliant query workflows

• Working knowledge of risk adjustment concepts and HCC validation where applicable to supported populations.

General Job Duties

• Performs other duties as assigned

Education: High School diploma or GED required.

Experience:At least 3 years of experience physician/provider coding required.

Certification/License/Registration: CPC or CCS-P required

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