Inpatient Senior Pediatric Coder - Hybrid

Job Title

Conducts concurrent and occasionally onsite medical chart reviews for pediatric and neonatal ICU patients.

Job Description

This position follows a hybrid model with 1-2 onsite days.

$15k Sign On Bonus eligible

Conducts concurrent and occasionally onsite medical chart reviews for pediatric and neonatal ICU patients. Collaborates with medical directors and staff to enhance the quality of physician documentation, ensuring a precise representation of the patients' severity of illness, anticipated risk of mortality, and the complexity of care administered. Ensures the accuracy, completeness, and compliance of medical coding and documentation for all pediatric patient encounters. Strives to optimize coding practices, minimize denials, and maintain the highest standards of data integrity.

Job Responsibility

1. Analyzes and interprets complex pediatric medical records to ensure accurate capture and coding of diagnoses, procedures, and appropriate levels of service, adhering to established coding guidelines (ICD-10-CM, CPT, HCPCS).

2. Applies advanced knowledge of pediatric anatomy, physiology, and medical terminology to interpret clinical documentation and assign the most accurate and specific codes.

3. Leverages coding resources, reference materials (e.g. online coding platforms, coding manuals, payer policies), and internal expertise to ensure accurate code selection, understand coding rules, and apply guidelines effectively.

4. Demonstrates a comprehensive understanding of the impact of coding decisions on the revenue cycle, including reimbursement, denials, and compliance.

5. Proactively facilitates clarification of provider clinical documentation to ensure accuracy, completeness, and integrity in the medical record, using effective communication techniques.

6. Maintains strict adherence to all government regulations, departmental policies, and contractual agreements related to coding and billing practices.

7. Performs comprehensive internal audits of coding practices to identify areas for improvement, reduce coding errors, and mitigate potential compliance risks.

8. Develops and implements corrective action plans to address identified coding deficiencies.

9. Collaborates effectively with physicians, nurses, and other healthcare providers to clarify documentation ambiguities, resolve coding discrepancies, and ensure accurate and complete medical records.

10. Acts as a coding resource for other members of the clinical and administrative teams in real-time.

11. Develops and delivers targeted feedback and training to providers on documentation and coding best practices, focusing on areas for improvement and compliance requirements.

12. Creates and maintains educational materials related to coding and documentation guidelines.

13. Actively stays abreast of changes in coding guidelines, regulations (e.g., CMS updates, payer-specific policies), and coding software updates.

14. Proactively enhances coding skills through continuing education, professional certifications, and participation in industry conferences and webinars.

15. Stays updated on the latest advancements in pediatric medicine and their impact on coding practices.

Job Qualification

• High School Diploma or equivalent required.
• 3 - 5 years of technical experience, required.
• Minimum 1 year experience in pediatric coding and documentation at acute care facility, required.
• CPC certification, required. CPEDC certification, preferred. CCS/CIC certification, preferred.
• Prior experience with inpatient facility coding, preferred.

This position follows a hybrid model, with 12 on-site days per week and the remainder remote.

*Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).