Medical Coder

Pediatrix•,

1d•Remote

About The Position

The Coding Specialist is responsible for coordinating and participating in the coding of medical services from a variety of complex records and coding edits to include diagnosis, treatment of illness and procedures performed while ensuring accuracy of work and adherence to established coding procedures of ICD-10 and CPT-4 in the ambulatory practice setting. This role ensures compliance with all applicable regulations, ensures compliant and correct reimbursement, and supports clinical and administrative staff in understanding documentation and coding requirements.

Requirements

High school diploma or equivalent required
One or more of the following certifications required or preferred: CPC (Certified Professional Coder) – AAPC, CCS-P (Certified Coding Specialist – Physician-based) – AHIMA, CPC-A, COC, or equivalent credential considered with relevant experience.
Minimum of 2 years of medical coding experience in an ambulatory or outpatient setting (e.g., family medicine, specialty practice, urgent care).
Strong understanding of ICD-10-CM, CPT, and HCPCS Level II coding systems.
Familiarity with E/M (Evaluation & Management) coding and documentation guidelines.
Strong attention to detail and analytical
Excellent written and verbal
Ability to interpret and apply complex regulatory and payer coding
Strong organizational and time-management
Discretion and respect for patient confidentiality (HIPAA compliance).

Nice To Haves

Associate’s degree in Health Information Management or related field preferred.
Experience with electronic health records (EHR) and practice management systems preferred.

Responsibilities

Review and analyze medical records to ensure accurate and complete coding of diagnoses (ICD-10-CM) and procedures (CPT-4/HCPCS).
Verify provider documentation supports assigned codes and meets payer-specific requirements.
Ensure coding compliance with federal and state regulations, payer policies, and internal standards.
Collaborate with providers, clinical staff, and billing teams to clarify documentation and resolve coding-related issues.
Manage and resolve claims manager edits, ensuring that all edits are reviewed, corrected, and documented in a timely manner.
Review claim denials from RCM through EEC process as needed.
Identify trends in denials or claim errors and communicate recurring issues to the Billing Manager or Practice Administrator for process improvement.
Track progress and resolution status of all assigned claims and accounts in coding work logs.
Stay current with changes in coding guidelines, payer rules, and industry best practices.
Maintain documentation of follow-up actions, payer communications, and claim resolutions in the billing system.
Participate in internal audits and quality improvement initiatives to enhance coding accuracy and compliance.
Provide education and feedback to clinicians and staff on documentation and coding requirements
Participate in SOX control review process.
Run, review, and work all daily, weekly, and monthly billing and reports.
Perform other job-related duties as assigned by Management such as insurance verification, attainment of prior authorization, gathering of patient demographic information, registration, charge posting and payment reconciliation.
Participate in coding calls and collaborate with Corporate Coding Department.