Professional Coding Specialist II

We are currently hiring a Professional Coder to join our team! This is a 1.0 FTE, Monday-Friday; 8:00am – 4:30pm. This will be a remote working position with the requirement to come on-site as needed to 455 Phalen Blvd. location in St. Paul, MN.

Purpose of position

Reviews a patient’s medical records after a visit or procedure to translate information into appropriate evaluation and management, diagnostic, and procedural codes that insurers use to process claims for the work performed by the provider.

Compensation & Benefits Information

The hourly wage for this opportunity is $26.68 to $40.05 /hour, with a median wage of $33.37/hour. Pay is dependent on several factors including relevant work experience, education, certification & licensure, and internal equity. Hourly pay is just one part of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for .5 FTE and above.

Core Responsibilities and Duties

Compliant Coding

• Reviews clinical documentation to assign diagnostic and procedural codes to professional claims according to the appropriate classification system.
• Audits charges to ensure appropriateness and modifiers are added as needed.
• Strives to maintain productivity standards defined by job duties.
• Maintains accuracy standards as measured by periodic audit, with 95% accuracy in diagnostic and procedural coding.
• Ensures accurate, timely, and appropriate assignment of ICD-10 and Current Procedural Terminology (CPT) (including E/M) for the purposes of billing, internal and external reporting, research, and compliance with regulatory and payer guidelines.
• Understand NCCI guidelines, Medical Necessity, NCD and LCD’s.
• Utilizes all references available; 3M encoder and reference package, ICD-10 and CPT code books, and government websites to ensure appropriate coding.
• Follows HIPAA, Joint Commission, and CMS Guidelines
• Maintains up-to-date knowledge on requirements set forth by the Centers for Medicare and Medicaid Services (CMS), other third-party payer requirements, and AMA CPT.
• Abides by the standards of ethical coding and adheres to official coding guidelines.
• Assists with training and review of coders
• May participate in interdepartmental committees to develop or enhance current or updated workflow.

Customer Service

• Serves as a liaison between department, physicians, and other relevant staff members by answering questions or providing support as issues arise.
• Provides education and support regarding the relationship between coding and documentation as needed to clinicians, management, or applicable support staff.

Technology, Policies and Procedures

• Demonstrates competency in organizational systems including Microsoft Office, electronic medical record, online resources, and other relevant technology to perform all necessary coding functions.
• Adheres to all organization and department policies, guidelines, workflow to eliminate errors in practice.
• Adheres to organization and department attendance policy.
• Independently completes annual training as assigned.
• Completes self-assessment timely and with contributing comments.

Actively engages with leadership through identification and execution of changes in workflow and policy to improve department work.

• Consistently provides constructive feedback.

Performs other assignments and projects as assigned.

• Willing to adapt to new processes, workflows, and system changes
• Ability to learn new information quickly

Qualifications

Required

• Required certifications: CPC, CCS-P, RHIT, RHIA, or appropriate AAPC specialty certification.
• Minimum 7 years’ experience in professional coding in pediatric setting or manager approved relative experience.

Preferred

• COSC (AAPC - Certified Orthopedic Surgery Coder) or
• CEMC (AAPC – Certified Evaluation and Management Coder)

Knowledge, Skills and Abilities

Coder must have proficient knowledge in medical terminology and codes, hospital policies, and government regulations. Must have clear communication and active listening skills to interact with a diverse staff and diverse functions. Position requires problem solving skills for both straightforward and complex coding concerns. Must be well-versed in conflict management and stay level-headed and positive during stressful situations. Must have an attention to detail in order to accurately identify coding and billing errors. As an independent worker, this position requires organizational and time management skills to maintain workload and productivity. Must be able to adapt to an ever-changing role with evolving responsibilities. Coder must be able to collaborate with others and work as a team. Must be proactive in setting up oneself for success to ensure tasks get done on time and with minimal supervision.

At Gillette Children’s, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential.

Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws.

Gillette Children’s is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.

To learn more about working at Gillette Children's, please visit https://www.gillettechildrens.org/careers.

Gillette Children's participates in the U.S. Department of Homeland Security (DHS) E-Verify program which is an internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. If E-Verify cannot confirm that you are authorized to work, Gillette will give you written instructions and an opportunity to contact DHS or the Social Security Administration (SSA) to resolve the issue before Gillette takes any further action. Please visit https://www.e-verify.gov/ for further details regarding E-Verify.