Professional Fee Coder III

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

As a Professional Fee Coder III, you will be responsible for monitoring, reviewing, and accurately applying coding principles to clinical documentation received from ambulatory areas to support reimbursement, research, and regulatory compliance. Areas of focus may include Gastroenterology—such as General and Colorectal Surgery—and may also extend to Head and Neck or Breast Surgery, depending on departmental needs. You will assign appropriate diagnosis codes, CPT codes, and modifiers based on documentation within the medical record, ensuring adherence to federal coding guidelines. Additionally, you will identify and resolve billing discrepancies to ensure timely and accurate claim submission.

A caregiver in this role works days between 5:00 a.m. — 3:30 p.m.

A caregiver who excels in this role will:

• Monitor, review and apply correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research and compliance.

• Identify and apply diagnosis codes, cot codes and modifiers as appropriately supported by the medical record in accordance with federal regulations.

• Ensure that billing discrepancies are held and corrected.

• Compare and reconcile daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges and manual data entry.

• Maintain records to be used for reconciliation and charge follow up.

• Investigate and resolve charge errors.

• Meet coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.

• Manage professional held claims within the CCF claims processing system.

• Review, abstract and process services from surgical operative report.

• Review, communicate and process physician attestation forms.

• Communicate with physicians and other CCF departments (co-surgery) to resolve documentation discrepancies.

• Assist with Evaluation and Management (E&M) audits and other reimbursement reviews.

• Review and resolve E&M denials within the denial database.

Minimum qualifications for the ideal future caregiver include:  

• High School Diploma / GED

• Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college

• Knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology

• Three years of coding to include one year of complex coding experience in a health care environment and or medical office setting

• Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) or Certified Outpatient Coder (COC) by American Academy of Professional Coders

• Candidate must currently be employed as a Professional Coder II at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of a Professional Coder II

• Coding assessment relevant to the work may be required

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2

Physical Requirements:

• Typical physical demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard.

• Manual dexterity required to locate and lift medical charts.

• Ability to work under stress and to meet imposed deadlines.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.