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.
• Reviewing 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.
• Communicates 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.
• Participating 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).
• Participates 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.
• Performs a variety of other Coding Compliance duties as needed.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policy.
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
• Performs other job-related duties within the job scope as requested by Management of Coding.
• Embodies the principles of the corporate Mission Statement and Philosophy at all times.
• Complies with departmental and company-wide policies and procedures.

Education/Experience: 

• 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. 

Knowledge/Skills: 

• 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.