Medical Coder

Key Responsibilities

• Review clinical documentation and assign accurate CPT, HCPCS, ICD-10, and E/M codes for professional services.
• Ensure all coding complies with national coding standards, payer requirements, and Hope Network policies.
• Apply appropriate modifiers and verify correct place of service (POS) coding.
• Maintain current knowledge of CPT, HCPCS, ICD-10, and reimbursement guidelines.
• Query providers regarding documentation deficiencies identified through pre-bill audits.
• Collaborate with providers to clarify documentation and recommend appropriate code selection or downcoding when necessary.
• Provide coding guidance and education to providers and staff across Hope Network locations.
• Review and resolve coding-related claim edits, denials, and payer rejections.
• Submit SAL change requests to correct billing information, including place of service, contact type, and attendance.
• Aid billing staff with coding questions on outstanding accounts to improve reimbursement and collections.
• Support reviews of overpayments and reimbursement discrepancies.

Reporting & Process Improvement

• Analyze coding reports to identify trends related to CPT codes, diagnosis codes, modifiers, and documentation.
• Compile coding statistics and prepare reports for the Revenue Management Director.
• Present coding findings and trends to Business Directors as needed.
• Support billing office workflows and identify opportunities to improve coding accuracy and operational efficiency.

Qualifications

• Education & Certifications:
• Associate's degree in Business, Finance, Health Administration, or a related field, or an equivalent combination of education and experience.
• Current professional coding certification (CPC, CCS-P, or equivalent) from a nationally recognized organization.
• Experience:
• 2–4 years of professional medical coding experience.
• Experience coding professional healthcare services, including E/M coding, required.
• Knowledge, Skills & Abilities:
• Advanced knowledge of CPT, HCPCS, ICD-10, modifiers, and payer-specific coding requirements.
• Ability to interpret clinical documentation and apply accurate coding principles.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office, electronic billing systems, and healthcare software.
• Ability to prioritize multiple responsibilities while maintaining a high level of accuracy.
• Ability to work collaboratively with providers, billing staff, leadership, and cross-functional teams.
• Valid driver's license with the ability to travel between Hope Network locations as needed.