Professional Coding Specialist II

Gillette Children's•St Paul, MN

2d•Remote

About The Position

Gillette Children’s is hiring a Professional Coding Specialist II to review patient medical records after visits or procedures and translate the documentation into appropriate evaluation and management, diagnostic, and procedural codes used by insurers to process claims. The position is 1.0 FTE, Monday through Friday, 8:00 a.m. to 4:30 p.m. It is remote, with onsite attendance required as needed at the 455 Phalen Blvd. location in St. Paul, Minnesota. The coder ensures professional claims are coded accurately, appropriately, and on time in accordance with classification systems, regulatory and payer requirements, and ethical coding standards. The role also audits charges, supports clinicians and staff with coding and documentation questions, may assist with training and coder reviews, and contributes to workflow and policy improvements. The position requires a qualifying coding credential and at least seven years of professional coding experience in a pediatric setting, or manager-approved relevant experience. The hourly wage is $26.68 to $40.05, with a median wage of $33.37; pay depends on factors including relevant experience, education, certification and licensure, and internal equity.

Requirements

One of the following required certifications: CPC, CCS-P, RHIT, RHIA, or an appropriate AAPC specialty certification.
At least 7 years of professional coding experience 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.
Attention to detail to accurately identify coding and billing errors.
Organizational and time-management skills to manage workload and productivity independently.
Ability to adapt to evolving responsibilities, collaborate with others, work as part of a team, and complete tasks on time with minimal supervision.

Nice To Haves

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

Responsibilities

Review clinical documentation and assign diagnostic and procedural codes to professional claims using the appropriate classification system.
Audit charges for appropriateness and add modifiers as needed.
Maintain productivity standards and accuracy standards, including 95% accuracy in diagnostic and procedural coding as measured by periodic audit.
Ensure accurate, timely, and appropriate assignment of ICD-10 and CPT codes, including evaluation and management codes, for billing, reporting, research, and compliance purposes.
Apply NCCI guidelines, medical necessity requirements, and national and local coverage determinations.
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, and CMS guidelines, as well as official coding guidelines and ethical coding standards.
Maintain current knowledge of CMS, third-party payer, and AMA CPT requirements.
Assist with coder training and review.
Serve as a liaison among the department, physicians, and other relevant staff by answering questions and providing support.
Provide education and support to clinicians, management, and applicable support staff about the relationship between coding and documentation.
Use organizational systems, including Microsoft Office, the electronic medical record, online resources, and other relevant technology, to perform coding functions.
Follow organizational and departmental policies, guidelines, workflows, and attendance policy; complete assigned annual training and self-assessments on time.
Engage with leadership to identify and implement workflow and policy improvements, and provide constructive feedback.
Adapt to new processes, workflows, and system changes, and learn new information quickly.
Complete other assignments and projects as assigned.