Coder Physician

Pro Fee coder with recent and multiple years' experience coding in a children's hospital or extensive pediatric experience. This role will be for multi-specialty coding for both medicine and surgical cases in include office and hospital EM coding and procedures. The role can be utilized in areas where the experience is strongest, thus candidates do not need to be experience all specialties but should have experience in multiple specialties. Epic and 3M 360 CAC experience required. Schedule can be flexible after initial training. For initial training candidate must be available for the first week between 8a and 4p PST. Post initial training 50% of the shift should be worked during this timeframe. This is an 8 week project. Skill & Competency Requirements (Office & Hospital E/Ms and Professional Procedures) Core Professional Fee Coding Knowledge Advanced knowledge of ICD-10-CM, CPT, and HCPCS Level II Strong understanding of professional fee billing principles, including provider vs. facility services Ability to correctly assign: Primary and secondary diagnoses to support medical necessity CPT/HCPCS codes for professional services Appropriate modifiers to ensure accurate reimbursement Knowledge of payer-specific professional fee rules, including Medicaid, managed care, and commercial payers Evaluation & Management (E/M) Coding - Office & Hospital Proficiency in coding office-based E/M services (new and established patient visits) Strong experience coding hospital-based E/M services, including: Initial hospital care Subsequent hospital care Discharge day management Observation E/M services Emergency Department E/Ms (when applicable to pro fee workflows) Thorough understanding of current E/M guidelines, including: Medical Decision Making (MDM) Time-based coding Ability to accurately distinguish between: New vs. established patient status Consults vs. non-consult services (per payer rules) Appropriate use of E/M-related modifiers (e.g., -25, -24, -57) Professional Procedure Coding Skills Proficiency coding provider-performed procedures, including: Minor bedside and clinic procedures Diagnostic and therapeutic procedures Surgical procedures billed on a professional claim Ability to interpret and code from: Provider progress notes Operative reports and procedure notes Procedure addenda and attestations Knowledge of global surgical package rules, including: Global periods Separately reportable E/M services Post-operative care and follow-up services Accurate application of procedural modifiers, such as: -26 (Professional component) -50, -51, -59 -LT/-RT -76/-77 Understanding of assistant-at-surgery and co-surgeon billing (when applicable) Pediatric & Specialty-Specific Expertise Strong understanding of pediatric anatomy, physiology, and clinical presentation Experience coding age-specific diagnoses and procedures Familiarity with pediatric subspecialties commonly billing professional fees, including: Pediatric surgery Cardiology Orthopedics Neurology and neurosurgery Gastroenterology (including endoscopic procedures) Oncology and hematology Pulmonology and critical care Knowledge of congenital and chronic pediatric conditions affecting E/M complexity and ongoing care Clinical Documentation Review & Interpretation Ability to review provider documentation for: Visit level accuracy Medical necessity Procedure completeness Skilled at identifying: Underdocumented or overdocumented E/M elements Missing or unclear procedural details Ability to apply official coding guidelines when documentation supports only limited code selection Provider Query & Education Collaboration Experience querying providers when documentation is insufficient, unclear, or conflicting Knowledge of AHIMA/ACDIS-compliant professional fee query standards Ability to communicate clearly and professionally with providers regarding: E/M leveling Procedural documentation requirements Willingness to support provider education efforts related to professional coding accuracy 2 + years' experience coding for either a children's hospital or extensive pediatric experience Epic Experience 3M 360 CAC experience Ok with a short term assignment Able to work M-F with the majority of the shift between 8a-4p PST Able to pick up new workflows and technology easily Able to ramp up productivity in 4 weeks Maintain 95% accuracy in all coding Good written and verbal communication