Home and Stone Investments
ProFee Edits/Denials Specialist
Home and Stone Investments, St. Petersburg, Florida, United States, 33739
Description
The ProFee Edits/Denials Specialist is responsible for reviewing front‑end edits and back‑end denials related to physician documentation and charges to ensure the accurate designation of diagnosis, procedure, and modifier codes. This role supports the revenue integrity process by identifying and correcting errors, resolving denials, and maintaining compliance with established coding and payer guidelines. The specialist contributes to the overall efficiency and accuracy of the ProFee team and assists with client satisfaction and quality outcomes.
Essential Functions
Review client medical records to ensure accurate ICD‑10‑CM diagnosis and CPT/HCPCS procedure code assignment, including appropriate modifiers.
Review and resolve front‑end edits and back‑end denials to ensure accurate claim submission and timely reimbursement.
Complete and maintain a daily edits/denials log documenting resolution and root causes.
Identify trends and recurring issues contributing to denials and communicate findings to leadership for process improvement.
Adjust edits and update claims based on client or payer requirements.
Demonstrate proficiency in coding and maintain a minimum of 95% accuracy.
Adhere to AHIMA’s Standards of Ethical Coding and all client‑specific policies and procedures.
Meet or exceed productivity and quality standards as established by the department.
Collaborate with colleagues and leadership to resolve complex billing or documentation issues.
Participate in ongoing training and education to maintain current knowledge of coding and payer regulations.
Additional Job Duties
Perform other duties as assigned based on company needs and client projects.
Additional Qualifications
RHIA, RHIT, CCS, or CCS‑P credential (active and in good standing with AHIMA), or CPC credential (active and in good standing with AAPC).
Minimum of three (3) years of physician‑based coding experience and/or billing edit/denial remediation experience.
Knowledge of hospital and/or physician billing systems.
Strong written and verbal communication skills with the ability to explain complex information clearly.
Proficient in Microsoft Word, Excel, Outlook, and EHR systems.
Demonstrated analytical skills with the ability to identify root causes and corrective actions.
High attention to detail and accuracy in repetitive tasks.
Ability to work independently and collaboratively in a fast‑paced environment.
Ability to maintain positive working relationships with internal teams and external clients.
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Essential Functions
Review client medical records to ensure accurate ICD‑10‑CM diagnosis and CPT/HCPCS procedure code assignment, including appropriate modifiers.
Review and resolve front‑end edits and back‑end denials to ensure accurate claim submission and timely reimbursement.
Complete and maintain a daily edits/denials log documenting resolution and root causes.
Identify trends and recurring issues contributing to denials and communicate findings to leadership for process improvement.
Adjust edits and update claims based on client or payer requirements.
Demonstrate proficiency in coding and maintain a minimum of 95% accuracy.
Adhere to AHIMA’s Standards of Ethical Coding and all client‑specific policies and procedures.
Meet or exceed productivity and quality standards as established by the department.
Collaborate with colleagues and leadership to resolve complex billing or documentation issues.
Participate in ongoing training and education to maintain current knowledge of coding and payer regulations.
Additional Job Duties
Perform other duties as assigned based on company needs and client projects.
Additional Qualifications
RHIA, RHIT, CCS, or CCS‑P credential (active and in good standing with AHIMA), or CPC credential (active and in good standing with AAPC).
Minimum of three (3) years of physician‑based coding experience and/or billing edit/denial remediation experience.
Knowledge of hospital and/or physician billing systems.
Strong written and verbal communication skills with the ability to explain complex information clearly.
Proficient in Microsoft Word, Excel, Outlook, and EHR systems.
Demonstrated analytical skills with the ability to identify root causes and corrective actions.
High attention to detail and accuracy in repetitive tasks.
Ability to work independently and collaboratively in a fast‑paced environment.
Ability to maintain positive working relationships with internal teams and external clients.
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