Professional Coding Specialist II

Gillette Children's•Saint Paul, MN

3d•$27 - $40•Remote

About The Position

The Professional Coding Specialist II reviews patient medical records after visits or procedures and translates clinical information into appropriate evaluation and management, diagnostic, and procedural codes used by insurers to process provider claims. The position assigns codes for professional claims in accordance with applicable classification systems, payer and regulatory requirements, and official coding guidelines. It audits charges, applies modifiers as needed, and maintains defined productivity and accuracy standards, including 95% accuracy in diagnostic and procedural coding. The role uses available coding references and tools to ensure accurate, timely coding for billing, reporting, research, and compliance purposes. It stays current with CMS, third-party payer, and AMA CPT requirements and follows HIPAA, Joint Commission, and CMS guidelines. The specialist also supports coder training and review, may contribute to interdepartmental workflow improvements, and serves as a liaison to physicians and other staff by answering coding questions and providing education about coding and documentation. This is a remote position with a requirement to work onsite as needed at the 455 Phalen Blvd. location in St. Paul, Minnesota. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., at 1.0 FTE. The hourly wage range is $26.68 to $40.05, with a median wage of $33.37. Pay depends on factors including relevant experience, education, certification or licensure, and internal equity. Gillette Children's offers a competitive benefits package, including a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for employees at 0.5 FTE and above.

Requirements

One of the following required certifications: CPC, CCS-P, RHIT, RHIA, or an appropriate AAPC specialty certification.
At least 7 years of experience in professional coding in a pediatric setting, or manager-approved relevant experience.
Proficient knowledge of medical terminology and codes, hospital policies, and government regulations.
Clear communication and active listening skills to interact with diverse staff and functions.
Problem-solving skills for straightforward and complex coding concerns.
Conflict-management skills and the ability to remain level-headed and positive in stressful situations.
Strong attention to detail to identify coding and billing errors accurately.
Organizational and time-management skills to manage workload and productivity as an independent worker.
Ability to adapt to evolving responsibilities, collaborate as part of a team, and complete tasks on time with minimal supervision.

Nice To Haves

COSC (AAPC Certified Orthopedic Surgery Coder).
CEMC (AAPC Certified Evaluation and Management Coder).

Responsibilities

Review clinical documentation and assign diagnostic and procedural codes to professional claims according to the appropriate classification system.
Audit charges for appropriateness and add modifiers as needed.
Maintain productivity standards and coding accuracy standards, including 95% accuracy in diagnostic and procedural coding as measured by periodic audits.
Assign ICD-10 and CPT codes, including evaluation and management codes, accurately and promptly for billing, internal and external reporting, research, and compliance purposes.
Apply NCCI guidelines and medical necessity requirements, including NCDs and LCDs.
Use available references, including the 3M encoder and reference package, ICD-10 and CPT code books, and government websites, to support appropriate coding.
Follow HIPAA, Joint Commission, CMS, payer, AMA CPT, and official ethical coding guidelines.
Maintain current knowledge of CMS and other third-party payer requirements and AMA CPT requirements.
Assist with training and review of coders.
Participate as needed in interdepartmental committees to develop or improve workflows.
Serve as a liaison between the department, physicians, and other relevant staff by answering questions and providing support when issues arise.
Provide education and support about the relationship between coding and documentation to clinicians, management, and applicable support staff.
Use organizational systems, Microsoft Office, electronic medical records, online resources, and other relevant technology to perform coding functions.
Follow organizational and departmental policies, guidelines, workflows, and attendance policies.
Complete assigned annual training independently and submit self-assessments on time with relevant comments.
Engage with leadership to identify and implement workflow and policy improvements, and provide constructive feedback.
Perform other assigned tasks and projects; adapt to new processes, workflows, and system changes and learn new information quickly.