Medical Coder

Overview

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.

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.

Qualifications

Education:

• High school diploma or equivalent required; Associate’s degree in Health Information Management or related field preferred.
• 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.

Experience Industry: Healthcare

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.
• Experience with electronic health records (EHR) and practice management systems preferred.

Skills/Abilities:

• 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).

Benefits and Compensation

Take great care of the patient, every day and every way.TM At Pediatrix & Obstetrix, that’s not only our motto at work each day; it’s also how we view our employees and their families. We know that our greatest asset is YOU.

We take pride in offering comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being. Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions. Our benefit programs are just one of the many ways Pediatrix & Obstetrix helps our employees take care of themselves and their families.

About Us

Pediatrix Medical Group is one of the nation’s leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives.

Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: www.pediatrix.com/careers.

Pediatrix is an Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Originally posted on Himalayas