Coder, Provider Practice, Pediatrics
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
About the position
The Coder for Provider Practice in Pediatrics at Sanford Health plays a crucial role in ensuring accurate coding and documentation for medical services provided in various settings, including clinics and Ambulatory Surgery Centers (ASC). This position requires a thorough understanding of coding guidelines and regulations, particularly those related to Medicare and Commercial Carrier workflows. The coder will serve as a resource for healthcare providers, helping them understand covered indications and the necessary documentation to support claims. In this role, the coder will be responsible for reviewing medical documentation from physicians and other healthcare providers, assigning appropriate modifiers, diagnostic, and procedure codes for various medical conditions and treatments. This includes the use of the International Classification of Diseases - Tenth Edition - Clinical Modification (ICD-10-CM), Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT) coding. The coder must ensure compliance with official coding standards and regulatory guidelines while also participating in coding team meetings and serving as a subject matter expert. The position requires self-motivation and the ability to work independently while managing multiple tasks. The coder will also be involved in the denial review and appeals management process, preparing supporting documents and information to facilitate appeals. Additionally, the coder will monitor and validate physician charge capture, ensuring that all coding is accurate and reflects the services provided. This role is essential in improving the accuracy of medical record documentation and ensuring appropriate reimbursement for services rendered.
Responsibilities
• Serve as a resource for providers in understanding covered indications and supporting documentation.
,
• Support technical and professional services in provider clinics and Ambulatory Surgery Centers (ASC).
,
• Maintain a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units.
,
• Understand and support Medicare and Commercial Carrier workflows related to daily coding and denial review.
,
• Prepare supporting documents and information for the appeal process.
,
• Monitor and validate physician charge capture.
,
• Review medical documentation and assign modifiers, diagnostic, and procedure codes according to classification systems.
,
• Provide accurate and timely ICD-10-CM coding of diagnoses, HCPCS, and CPT coding.
,
• Review and audit medical record documentation to ensure compliance with coding standards.
,
• Convey coding guidelines to physicians and healthcare providers to improve documentation accuracy.
Requirements
• Associate degree in Health Information Technology or Certification in Coding required.
,
• Specific knowledge of diagnostic and procedural terminology is preferred.
,
• Successful coursework in ICD diagnosis, CPT, and HCPCS coding schemes is preferred.
,
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification is required.
,
• Certified Professional Coder (CPC) or equivalent coding certification is required.
Nice-to-haves
• Knowledge of medical terminology or human anatomy/physiology is preferred.
Benefits Apply tot his job
The Coder for Provider Practice in Pediatrics at Sanford Health plays a crucial role in ensuring accurate coding and documentation for medical services provided in various settings, including clinics and Ambulatory Surgery Centers (ASC). This position requires a thorough understanding of coding guidelines and regulations, particularly those related to Medicare and Commercial Carrier workflows. The coder will serve as a resource for healthcare providers, helping them understand covered indications and the necessary documentation to support claims. In this role, the coder will be responsible for reviewing medical documentation from physicians and other healthcare providers, assigning appropriate modifiers, diagnostic, and procedure codes for various medical conditions and treatments. This includes the use of the International Classification of Diseases - Tenth Edition - Clinical Modification (ICD-10-CM), Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT) coding. The coder must ensure compliance with official coding standards and regulatory guidelines while also participating in coding team meetings and serving as a subject matter expert. The position requires self-motivation and the ability to work independently while managing multiple tasks. The coder will also be involved in the denial review and appeals management process, preparing supporting documents and information to facilitate appeals. Additionally, the coder will monitor and validate physician charge capture, ensuring that all coding is accurate and reflects the services provided. This role is essential in improving the accuracy of medical record documentation and ensuring appropriate reimbursement for services rendered.
Responsibilities
• Serve as a resource for providers in understanding covered indications and supporting documentation.
,
• Support technical and professional services in provider clinics and Ambulatory Surgery Centers (ASC).
,
• Maintain a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units.
,
• Understand and support Medicare and Commercial Carrier workflows related to daily coding and denial review.
,
• Prepare supporting documents and information for the appeal process.
,
• Monitor and validate physician charge capture.
,
• Review medical documentation and assign modifiers, diagnostic, and procedure codes according to classification systems.
,
• Provide accurate and timely ICD-10-CM coding of diagnoses, HCPCS, and CPT coding.
,
• Review and audit medical record documentation to ensure compliance with coding standards.
,
• Convey coding guidelines to physicians and healthcare providers to improve documentation accuracy.
Requirements
• Associate degree in Health Information Technology or Certification in Coding required.
,
• Specific knowledge of diagnostic and procedural terminology is preferred.
,
• Successful coursework in ICD diagnosis, CPT, and HCPCS coding schemes is preferred.
,
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification is required.
,
• Certified Professional Coder (CPC) or equivalent coding certification is required.
Nice-to-haves
• Knowledge of medical terminology or human anatomy/physiology is preferred.
Benefits Apply tot his job