Coder Physician

Omega•Boca Raton, FL

12h

About The Position

This role is for a Pro Fee coder with recent and multiple years' experience coding in a children's hospital or extensive pediatric experience. The position involves multi-specialty coding for both medicine and surgical cases, including office and hospital EM coding and procedures. Candidates should have experience in multiple specialties, though not necessarily all. Epic and 3M 360 CAC experience is required. The schedule can be flexible after initial training, which requires availability between 8a and 4p PST for the first week. Post initial training, 50% of the shift should be worked during this timeframe. This is an 8-week project.

Requirements

Pro Fee coder with recent and multiple years' experience coding in a children's hospital or extensive pediatric experience
Experience in multi-specialty coding for both medicine and surgical cases
Experience in office and hospital EM coding and procedures
Epic and 3M 360 CAC experience
Advanced knowledge of ICD‑10‑CM, CPT®, and HCPCS Level II
Strong understanding of professional fee billing principles, including provider vs. facility services
Knowledge of payer‑specific professional fee rules, including Medicaid, managed care, and commercial payers
Proficiency in coding office‑based E/M services
Strong experience coding hospital‑based E/M services
Thorough understanding of current E/M guidelines, including Medical Decision Making (MDM) and time‑based coding
Proficiency coding provider‑performed procedures
Knowledge of global surgical package rules
Strong understanding of pediatric anatomy, physiology, and clinical presentation
Experience coding age‑specific diagnoses and procedures
Familiarity with pediatric subspecialties commonly billing professional fees, including Pediatric surgery, Cardiology, Orthopedics, Neurology and neurosurgery, Gastroenterology (including endoscopic procedures), Oncology and hematology, Pulmonology and critical care
Knowledge of congenital and chronic pediatric conditions affecting E/M complexity and ongoing care
Ability to review provider documentation for visit level accuracy, medical necessity, and procedure completeness
Skilled at identifying underdocumented or overdocumented E/M elements and missing or unclear procedural details
Experience querying providers when documentation is insufficient, unclear, or conflicting
Knowledge of AHIMA/ACDIS‑compliant professional fee query standards
Willingness to support provider education efforts related to professional coding accuracy

Responsibilities

Correctly assign primary and secondary diagnoses to support medical necessity
Correctly assign CPT/HCPCS codes for professional services
Correctly assign appropriate modifiers to ensure accurate reimbursement
Code office-based E/M services (new and established patient visits)
Code hospital-based E/M services, including initial hospital care, subsequent hospital care, discharge day management, observation E/M services, and Emergency Department E/Ms (when applicable to pro fee workflows)
Accurately distinguish between new vs. established patient status and consults vs. non-consult services (per payer rules)
Appropriately use E/M-related modifiers (e.g., -25, -24, -57)
Code provider-performed procedures, including minor bedside and clinic procedures, diagnostic and therapeutic procedures, and surgical procedures billed on a professional claim
Interpret and code from provider progress notes, operative reports and procedure notes, and procedure addenda and attestations
Apply global surgical package rules, including global periods, separately reportable E/M services, and post-operative care and follow-up services
Accurately apply procedural modifiers, such as -26 (Professional component), -50, -51, -59, -LT/-RT, -76/-77
Understand assistant-at-surgery and co-surgeon billing (when applicable)
Review provider documentation for visit level accuracy, medical necessity, and procedure completeness
Identify underdocumented or overdocumented E/M elements and missing or unclear procedural details
Apply official coding guidelines when documentation supports only limited code selection
Query providers when documentation is insufficient, unclear, or conflicting
Communicate clearly and professionally with providers regarding E/M leveling and procedural documentation requirements
Support provider education efforts related to professional coding accuracy