Pediatric Professional Coding Specialist III

Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment.

This position will be responsible for overseeing pediatric areas for coding assistance, including follow-up, as well as fielding staff questions around pediatric billing in general.

General Description

Senior subject matter expert responsible for the most complex pro fee coding portfolios and serving as a functional team lead through mentoring, training, and escalation support. Ensures compliant coding, high audit defensibility, and stable production across multisetting pro fee services in an academic, multispecialty and research enterprise.

Essential Job Duties

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position.

• Code and resolve the most complex, highrisk professional encounters including specialtyspecific procedures, highdollar services, complex modifier scenarios, and telehealth exceptions.

• Serve asan escalationresource for coding disputes, payer policy conflicts, and documentation challenges;providedefinitive guidance consistent with coding standards.

• Support training and mentoring of Coding Specialists I-II;assistwith onboarding, competency development, job aid creation, and informal inservice education.Ability to teach and coach peers; translate guidelines into practical, consistent coding decisions and training artifacts.

• Contribute to coding quality management through audits and trend analysis; recommend process improvements and targeted education based on findings.High autonomy, prioritization skills, and risk ownership for auditsensitive services and complex claims.

• Partner with clinical leadership and compliance to support documentation improvement and mitigate coding/audit risk; support consistent query practices.

• Expert coding knowledge across assigned specialties and settings; advanced modifier and payer policy interpretation; strong documentationstandardexpertise.

• Strong analytical and communication skillsto influencedocumentation improvement and reduce downstream denials.

General Job Duties

• Performs other duties as assigned

Minimum Requirements

Education: High School diploma or GED required.

Experience: At least 5 years of experience of physician/provider coding required.

Certification/License/Registration: CPC or CCS-P required - Additional specialty credential required such as CPMA, CEMC, CRC or other specialty credentials (e.g. COPC, CEDC, CGIC, CIRCC or other)

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