What are the responsibilities and job description for the Billing and Coding Specialist position at Pediatric Therapy Associates?
The Coding Specialist supports PTA by ensuring accurate, compliant, and optimized medical coding across the organization. This role serves as a subject matter expert in coding guidelines, documentation requirements, payer policies, and regulatory compliance. The Coding Specialist works closely with providers, clinical staff, billing personnel, and office leadership to improve documentation integrity, coding accuracy, clean claim submission, and overall revenue cycle performance.
The Coding Specialist also plays a key role in adopting and optimizing new technologies, including AI-enabled coding tools and workflow automation, to improve efficiency, accuracy, consistency, and scalability within the revenue cycle.
Key Responsibilities
Essential Functions
Culture Champion: Encourages, motivates, and models engagement in assigned responsibilities in a manner that reflects PTA's mission of “Doing More, Expecting More, and Meeting Milestones.”
Customer/Patient Supporter: Supports a positive patient experience by ensuring coding accuracy and appropriate billing outcomes. Assists with resolving patient and payer questions related to coding professionally and clearly.
Coding Professional: Reviews provider documentation and accurately assigns appropriate diagnosis, CPT, and HCPCS codes. Ensures coding follows current regulatory requirements, payer policies, and PTA guidelines.
Coding Quality & Accuracy: Identifies coding errors, inconsistencies, missing documentation, and opportunities for improvement. Performs routine coding reviews to support accurate and compliant claims.
Technology & Innovation Champion: Supports the implementation and optimization of AI-assisted coding tools, automation platforms, and other technology designed to improve coding accuracy and efficiency. Helps evaluate workflows and serves as a resource to team members during technology implementation.
Clinical Documentation Integrity: Works closely with providers and clinical teams to improve the accuracy, completeness, and consistency of clinical documentation. Provides education and feedback regarding documentation requirements and appropriate code selection.
Denial & Audit Specialist: Reviews coding-related claim denials and identifies trends and root causes. Recommends corrective actions and collaborates with billing staff to reduce recurring denials. Participates in internal and external coding audits and assists with audit responses and corrective action plans.
Payer & Regulatory Compliance: Maintains current knowledge of payer-specific coding requirements, authorization requirements, regulatory changes, and applicable coding guidelines. Communicates important changes to appropriate team members.
Team Collaborator: Works closely with colleagues, billing staff, providers, and clinical teams to ensure alignment between coding, billing, documentation, and authorization processes.
Subject Matter Expert: Serves as a resource for coding staff and providers regarding complex coding questions, documentation requirements, payer policies, and appropriate code selection.
Education & Training: Provides coding education, coaching, and ongoing support to clinical and administrative team members. Helps identify training opportunities based on coding errors, denials, audits, and regulatory changes.
Continuous Learner: Maintains current knowledge of coding guidelines, payer policies, regulatory requirements, industry best practices, AthenaOne updates, and emerging coding technologies. Actively participates in continuing education and applies new knowledge to improve team and organizational outcomes.
Process Improvement: Identifies opportunities to improve coding workflows, reduce manual processes, increase first-pass claim accuracy, and improve overall revenue cycle efficiency.
Reporting & Accountability: Monitors coding accuracy, denial trends, documentation issues, and other relevant coding metrics. Communicates findings and recommendations to revenue cycle leadership.
Special Projects: Assists with revenue cycle initiatives, system implementations, audits, workflow redesign, technology implementation, and other special projects as assigned.
Other Duties: Performs other related duties and responsibilities as assigned.
The Coding Specialist also plays a key role in adopting and optimizing new technologies, including AI-enabled coding tools and workflow automation, to improve efficiency, accuracy, consistency, and scalability within the revenue cycle.
Key Responsibilities
Essential Functions
Culture Champion: Encourages, motivates, and models engagement in assigned responsibilities in a manner that reflects PTA's mission of “Doing More, Expecting More, and Meeting Milestones.”
Customer/Patient Supporter: Supports a positive patient experience by ensuring coding accuracy and appropriate billing outcomes. Assists with resolving patient and payer questions related to coding professionally and clearly.
Coding Professional: Reviews provider documentation and accurately assigns appropriate diagnosis, CPT, and HCPCS codes. Ensures coding follows current regulatory requirements, payer policies, and PTA guidelines.
Coding Quality & Accuracy: Identifies coding errors, inconsistencies, missing documentation, and opportunities for improvement. Performs routine coding reviews to support accurate and compliant claims.
Technology & Innovation Champion: Supports the implementation and optimization of AI-assisted coding tools, automation platforms, and other technology designed to improve coding accuracy and efficiency. Helps evaluate workflows and serves as a resource to team members during technology implementation.
Clinical Documentation Integrity: Works closely with providers and clinical teams to improve the accuracy, completeness, and consistency of clinical documentation. Provides education and feedback regarding documentation requirements and appropriate code selection.
Denial & Audit Specialist: Reviews coding-related claim denials and identifies trends and root causes. Recommends corrective actions and collaborates with billing staff to reduce recurring denials. Participates in internal and external coding audits and assists with audit responses and corrective action plans.
Payer & Regulatory Compliance: Maintains current knowledge of payer-specific coding requirements, authorization requirements, regulatory changes, and applicable coding guidelines. Communicates important changes to appropriate team members.
Team Collaborator: Works closely with colleagues, billing staff, providers, and clinical teams to ensure alignment between coding, billing, documentation, and authorization processes.
Subject Matter Expert: Serves as a resource for coding staff and providers regarding complex coding questions, documentation requirements, payer policies, and appropriate code selection.
Education & Training: Provides coding education, coaching, and ongoing support to clinical and administrative team members. Helps identify training opportunities based on coding errors, denials, audits, and regulatory changes.
Continuous Learner: Maintains current knowledge of coding guidelines, payer policies, regulatory requirements, industry best practices, AthenaOne updates, and emerging coding technologies. Actively participates in continuing education and applies new knowledge to improve team and organizational outcomes.
Process Improvement: Identifies opportunities to improve coding workflows, reduce manual processes, increase first-pass claim accuracy, and improve overall revenue cycle efficiency.
Reporting & Accountability: Monitors coding accuracy, denial trends, documentation issues, and other relevant coding metrics. Communicates findings and recommendations to revenue cycle leadership.
Special Projects: Assists with revenue cycle initiatives, system implementations, audits, workflow redesign, technology implementation, and other special projects as assigned.
Other Duties: Performs other related duties and responsibilities as assigned.