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Role Description

We have an exciting opportunity for a Certified Coding Specialist with experience in Pediatric Specialty Coding to join our team.

The Coding Specialist is responsible for coordinating and participating in the coding of pertinent medical information from a variety of complex records and coding edits to include diagnosis, treatment of illness and procedures performed while ensuring accuracy of work adherence to established coding procedures of ICD-CM (International Classification of Diseases) and CPT-4 (Current Procedural Terminology).

• Perform concurrent audit of provider-selected coding data during the coding and billing process, interpreting medical records and updating and/or verifying all valid diagnoses, procedure codes, modifiers, providers, and place of service as determined by the coder.
• Participate in SOX control review (audit) processes.
• Review all pertinent medical records for diagnosis and procedures performed and documented while maintaining strict adherence to Pediatrix Compliance program guidelines.
• Analyze source of errors and issues in order to determine next steps (provider error, system or edit issue).
• Communicate to physicians by Electronic Mail all discrepancies in coding based on the medical record reviewed, per department guidelines and processes.
• Review and educate physicians, advanced nurse practitioners and other staff as necessary on documentation requirements and coding guidelines.
• Communicate to Coding management any claims edit updates needed, identified during concurrent audit of billing and coding.
• Review claim denials submitted to Coding by RCM for changes to coding and updates to system edits to prevent future denials. Troubleshoot denials for cause and determine resolution.
• Research and review third party payer guidance for establishment of system edits.
• Participate in company processes for obtaining facility medical records (view with direct access, request via online forms, send provider requests) as well as being the organization representative to provide other departments with records from certain sites for which coder has access.
• Maintain facility EMR system access as assigned (complete demographic forms, attend facility training, etc).
• Participate in audit, education, and coding team meetings to discuss solutions to coding and documentation scenarios identified during coder assessment of provider coding and billing selections.
• Facilitate new provider system access and training in charge capture systems.
• Timely and appropriate coding of services as required to meet production needs - Meet or exceed required departmental productivity standards on a consistent basis.
• Perform a variety of other Coding Compliance duties as needed.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policy.
• Present a positive, professional appearance and convey a professional demeanor in the performance of assigned duties.
• Perform other job-related duties within the job scope as requested by Management of Coding.
• Embody the principles of the corporate Mission Statement and Philosophy at all times.
• Comply with departmental and company-wide policies and procedures.

Qualifications

• Certified Professional Coder (CPC) or Certified Coding Specialist – Physician (CCS-P) designation required with current active status.
• Minimum of three years related experience and/or training; or equivalent combination of education and experience preferred in addition to certification.

Requirements

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and communicate them to physicians, coders, and other staff in a way that facilitates understanding.
• Software: Microsoft Office (Excel, Word, Outlook, Teams), Medical Coding reference resources, and various hospital, vendor or proprietary documentation and billing platforms.

Benefits

• Comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being.
• Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program.
• Some benefits are provided at no cost, while others require a cost share between employees and the company.
• Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.

Company Description

Pediatrix Medical Group is one of the nation’s leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group.

Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives.