At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Professional Fee Coder III:

Location

Cleveland

Facility

Remote Location

Department

Professional Coding Services-Finance:

Job Code

U99930

Shift

Days

Schedule

7:00am-3:30pm

Job Summary

Job Details

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. In this role, you will assign appropriate diagnosis codes, CPT codes, and modifiers based on the medical record while ensuring adherence to federal coding guidelines. You will also identify and resolve billing discrepancies to ensure timely and accurate claim submission. This position supports Cleveland Clinic’s mission and vision by helping submit clean claims for the services provided, ensuring accuracy, integrity, and high-quality patient care.

A caregiver in this role works remotely from 7: 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.

• Capture appropriate charges in accordance with CMS billing rules and regulations.

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

• Proficiency in coding and claims editing

• Internal 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

Preferred qualifications for the ideal future caregiver include:

• Urology surgical coding experience

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.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster.

Cleveland Clinic is pleased to be an equal employment opportunity employer.