What are the responsibilities and job description for the Certified Pediatric Coder position at Pediatrica Health Group?
About Pediatrica Health Group Inc.
Every day is a good day to prepare for a healthy tomorrow. Providing children and their families with equitable access to quality pediatric care to build a foundation for a lifetime of optimal health and wellness is what drives our team to deliver its best every day. It’s our purpose.
Offering focused care from tots to teens, our pediatric primary care providers and teams partner with families to foster good health and strong, thriving communities. Second-to-none medical staff and top-tier administrative professionals keep our practices running smoothly and make each patient experience the best we can offer.
Working in partnership with patients, families, and communities who put their trust in us for their care, we hold ourselves accountable to ensure equitable access to care, advocate to create impactful change, and continually learn and progress to create better outcomes and brighter futures. Together, we’re paving the way for kids to develop into healthy young adults. Rooted in these values, we continue to grow and serve. Are you ready to join us?
ESSENTIAL FUNCTIONS:
This position is responsible for reviewing, coding, and submitting accurate claims for pediatric medical services while ensuring compliance with current coding regulations and insurance requirements. The ideal candidate will have expertise in pediatric coding guidelines and work collaboratively with clinical and billing teams.
DUTIES AND RESPONSIBILITIES:
- Review clinical documentation and assign appropriate ICD-10, CPT, and HCPCS codes for pediatric diagnoses and procedures.
- Ensure coding compliance with federal regulations, payer policies, and organizational standards.
- Query providers when necessary for additional information or clarification to ensure accurate coding.
- Assist in the education of providers and staff regarding coding updates, documentation improvement, and regulatory requirements.
- Audit coded data for accuracy and provide feedback to clinical staff as needed.
- Submit clean claims for reimbursement in a timely manner and assist with denial management processes related to coding issues.
- Stay current with changes in coding guidelines, payer requirements, and pediatric coding best practices.
- Support revenue cycle management by ensuring optimal coding accuracy and maximizing reimbursement.
QUALIFICATIONS/REQUIREMENTS
- High school diploma or equivalent required.
- Certification as a Certified Pediatric Coder (CPC-P) required.
- Minimum of two years of medical coding experience, preferably in a pediatric healthcare setting.
- In-depth knowledge of pediatric-specific coding, medical terminology, and insurance guidelines.
- Proficient in using coding software, EMR systems, and Microsoft Office applications.
- Excellent attention to detail and organizational skills.
- Strong verbal and written communication skills.
- Commitment to maintaining patient confidentiality and adhering to HIPAA regulations.
SUPERVISORY RESPONSIBILITIES
- Not applicable
WORKING CONDITIONS
- General office working conditions
PHYSICAL DEMANDS
The physical demands described here are representative of those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch, or crawl; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust and to focus. Frequent travel is required, often up to several hours of driving per day. Ability to travel to, attend, and conduct sales presentations. Manual dexterity is required to use desktop computers and peripherals. Exposure to variable weather conditions is likely.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those that an employee must meet to perform the essential functions of his job successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
TRAVEL
Minimal; primarily local if required.
SAFETY HAZARDS OF THE JOB
Minimal Hazards