Neonatology Medical Coder

Description

Description

The Medical Coder will be responsible for accurately assigning diagnostic and procedure codes for Neonatology and NICU patient encounters, ensuring compliance with all applicable coding guidelines and regulatory requirements. This role primarily supports neonatal and newborn services, with potential crossover coding responsibilities in OB/GYN, laboratory, mammography, and women’s health services as needed. The ideal candidate will have strong expertise in ICD-10-CM and CPT coding and demonstrated experience in neonatal and critical care coding environments.

Responsibilities

Neonatology & NICU Coding:

• Review neonatal and NICU medical records, encounter forms, progress notes, and procedural documentation to accurately assign ICD-10-CM and CPT/HCPCS codes in accordance with official coding guidelines.
• Accurately code newborn and neonatal services, including:
• Initial and subsequent hospital care for normal and sick newborns (CPT 99460–99463, 99477–99480)
• Neonatal and pediatric critical care services (CPT 99468–99476)
• NICU daily management, discharge services, and transfer of care
• Gestational age, birth weight, and condition-specific ICD-10-CM diagnoses (P00–P96 series)
• Common neonatal procedures such as resuscitation, ventilation management, vascular access, and monitoring services
• Ensure appropriate selection of age-based, time-based, and acuity-driven codes, including correct documentation and calculation of critical care time.
  
  

Coding Accuracy & Validation

• Validate the accuracy and completeness of coded data to ensure alignment with provider documentation and payer requirements.
• Identify and resolve coding discrepancies through collaboration with neonatologists, pediatric providers, clinical teams, and revenue cycle staff.
• Ensure proper application of modifiers, bundled services, and NCCI edits specific to neonatal and NICU coding.
  
  

Compliance & Regulatory Adherence

• Ensure compliance with CMS guidelines, NCCI edits, LCDs, and payer-specific policies related to neonatology and newborn services.
• Maintain current knowledge of coding updates and regulatory changes impacting neonatal, pediatric, and maternal-child health services.
  
  

Quality Assurance & Auditing

• Conduct routine audits and quality reviews of neonatal and NICU coding to identify errors, trends, and opportunities for improvement.
• Support internal and external audits, appeals, and compliance initiatives related to neonatal and pediatric coding.
  
  

Productivity & Performance

• Meet or exceed established KPIs, including:
• =95% coding accuracy
• 48-hour charge entry turnaround
• Claim edit and denial reconciliation requirements
• Productivity standards of 60-100 charts per day, adjusted for neonatal and critical care complexity
  
  

Education & Collaboration

• Provide education and feedback to providers and clinical staff regarding neonatal documentation requirements and coding best practices.
• Collaborate with billing, revenue cycle, and clinical teams to resolve denials, underpayments, and coding-related issues.
  
  

Crossover Coding Support

• Provide additional coding support, as needed, for OB/GYN, laboratory, mammography, and women’s health services, ensuring consistent application of coding standards across service lines.
  
  

Requirements

• CPC or CCS certification required.
• Preferred minimum of 2–3 years of professional medical coding experience, with primary experience in Neonatology and/or NICU coding strongly preferred.
• Working knowledge of OB/GYN, laboratory, mammography, or women’s health coding considered a plus.
• Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding systems, with emphasis on neonatal, pediatric, and critical care services.
• Proficiency with coding software and EHR systems, Athena experience preferred.