Professional Fee Coder II

Lucile Salter Packard Children's Hospital at Stanford
United States, California, Palo Alto
725 Welch Road (Show on map)
Jun 10, 2025
Company Description At Lucile Packard Children's Hospital Stanford, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time. Job Description JOB SUMMARY This paragraph summarizes the general nature, level and purpose of the job. The Professional Fee Coder is part of a team which has full responsibility for the efficient and accurate flow of coded charges. Applies the appropriate diagnoses, surgical and procedural codes to individual patient health information for data retrieval, analysis and claims processing. Works closely with departments to optimize reimbursement, ensure charge capture, reduce late charges and provide feedback to providers. Provides physicians routine feedback on documentation and compliance standards. Resolves pre-bill edits and appropriate follow-up. Exercises judgment within generally defined practices and policies in selecting methods and techniques for obtaining solutions. Receives no instructions on routine work and general instructions on new assignments. ESSENTIAL FUNCTIONS The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct. * Adheres to official coding guidelines. * Applies CPT-4, ICD-9-CM, HCPCS and modifiers following coding guidelines. * Code all documented professional services and submit for billing. * Ensure coded services, provider charges and medical record documentation meet appropriate guidelines or standards. * Ensures all services are accounted for and billed. * Keeps abreast of coding guidelines and reimbursement reporting requirements. * Provides feedback to physicians related to documentation issues and/or revenue opportunities. * Queries physicians when code assignments are not straightforward or documentation in the record in inadequate, ambiguous, or unclear for coding purposes. * Utilize appropriate methods to ensure all documented professional services are submitted timely. * Utilizes correct coding practices to file clean claims aiding in improved cash flow. Qualifications MINIMUM QUALIFICATIONS Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying. Education: Associate's degree in a work-related field/discipline from an accredited college or university. Experience: Two (2) years of progressively responsible and directly related work experience. License/Certification: AHIMA Certified Coding Specialist-Physician-based by American Health Information Management Association or AAPC Certified Professional Coder by American Academy of Professional Coders or AHIMA Certified Coding Specialist by American Health Information Management Association or AHIMA Registered Health Information Administrator by American Health Information Management Association or AHIMA Registered Health Information Technician by American Health Information Management Association KNOWLEDGE These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education or licensure/certification. * Ability to adapt to and deal with change and ambiguity. * Ability to foster effective working relationships and build consensus. * Ability to plan, organize, prioritize, work independently and meet deadlines. * Ability to solve technical and non-technical problems. * Ability to utilize the ICD-9-CM & CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups. * Ability to work effectively with individuals at all levels of the organization. * Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues. * Knowledge of computer systems and software used in functional area. * Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases. PHYSICAL REQUIREMENTS The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job. Additional Information Pay Range Compensation is based on the level and requirements of the role. Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data. Typically, new team members join at the minimum to mid salary range. Minimum to Midpoint Range (Hourly): $48.34 to $54.79 Stanford Medicine Children's Health (SMCH) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SMCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.