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Doylestown, Pennsylvania, United States
Onsite
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Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment .
We are seeking an experienced Maternal-Fetal Medicine (MFM) Coder to manage high-risk OB coding. This role requires mastery of complex Chapter 15 ICD-10-CM guidelines and specialized fetal procedures. The role requires audit, review, and coding complex maternal and fetal anomalies.
**Ideal candidate will understand the nuances of global vs. split-care billing, complex E/M guidelines, and specialized fetal therapy procedures. This is a high-level position for an expert coder who can operate independently.**
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. Applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, wRVU integrity, 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 level selection, and documentation alignment. Advanced expertise in ICD‑10‑CM, CPT®, HCPCS, and modifiers; strong E/M coding proficiency and payer policy interpretation.
Resolve coding-related edits and denials by identifying root 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.
Provide real‑time guidance to peers on standard coding scenarios; promote consistency through best‑practice sharing.
Participate in internal quality review programs and implement education/corrective actions based on findings.
Proficiency in Epic professional coding work queues and encoder tools; ability to efficiently review documentation in the EHR across settings.
Analytical problem solving for denial/edits prevention; ability to identify documentation 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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