Medical Coder

About the Role

The Medical Coding Specialist is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.

Responsibilities

• Averages 10 front-end holds per hour
• Maintains a minimum of 90% coding accuracy
• Sets ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment
• Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses
• Ensures all diagnosis codes meet local and national medical necessity guidelines
• Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services
• Fulfills all HIPAA regulations and upholds the highest standards of privacy and confidentiality
• Independently reviews and resolves all assigned front-end claim holds
• Participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead
• Escalates identified client trends to the assigned Coding Team Lead
• Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification
• Maintains and completes all CEU requirements
• Performs other duties or tasks as assigned

Requirements

• Must hold a current AAPC or AHIMA Certification for a minimum of 3 years
• Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines
• Familiarity with proper English grammar, usage, and professional documentation standards
• Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues
• Ability to read, interpret, and apply policies, procedures, laws, and regulations
• Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures
• Demonstrated ability to exercise independent judgment in coding and claim resolution
• Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff
• Demonstrated commitment to maintaining confidentiality and safeguarding protected health information
• Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements
• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams)

Qualifications

• Minimum of 3+ years of professional coding experience

Skills

• Strong attention to detail
• Foundational coding knowledge
• Independent judgment in coding and claim resolution
• Excellent written and verbal communication skills
• Research and analysis skills
• Ability to adhere to HIPAA regulations
• Proficiency in Microsoft Office Suite

Benefits

• Generous Paid Time Off
• Best-in-Class Parental Leave
• Recognition & Rewards
• Comprehensive Insurance Coverage
• Optional Perks