Medical Coder

About the role

The Coding Specialist is responsible for coordinating and participating in the coding of medical services from a variety of complex records and coding edits to include diagnosis, treatment of illness and procedures performed while ensuring accuracy of work and adherence to established coding procedures of ICD-10 and CPT-4 in the ambulatory practice setting. This role ensures compliance with all applicable regulations, ensures compliant and correct reimbursement, and supports clinical and administrative staff in understanding documentation and coding requirements.

Responsibilities

• Review and analyze medical records to ensure accurate and complete coding of diagnoses (ICD-10-CM) and procedures (CPT-4/HCPCS).
• Verify provider documentation supports assigned codes and meets payer-specific requirements.
• Ensure coding compliance with federal and state regulations, payer policies, and internal standards.
• Collaborate with providers, clinical staff, and billing teams to clarify documentation and resolve coding-related issues.
• Manage and resolve claims manager edits, ensuring that all edits are reviewed, corrected, and documented in a timely manner.
• Review claim denials from RCM through EEC process as needed.
• Identify trends in denials or claim errors and communicate recurring issues to the Billing Manager or Practice Administrator for process improvement.
• Track progress and resolution status of all assigned claims and accounts in coding work logs.
• Stay current with changes in coding guidelines, payer rules, and industry best practices.
• Maintain documentation of follow-up actions, payer communications, and claim resolutions in the billing system.
• Provide education and feedback to clinicians and staff on documentation and coding requirements.
• Participate in coding calls and collaborate with Corporate Coding Department.

Requirements

• Education: High school diploma or equivalent required; Associate’s degree in Health Information Management or related field preferred.
• Experience: Minimum of 2 years of medical coding experience in an ambulatory or outpatient setting (e.g., family medicine, specialty practice, urgent care). Multispecialty coding preferred. Surgery Coding is strongly preferred.
• Skills: Strong attention to detail and analytical, Excellent written and verbal, Ability to interpret and apply complex regulatory and payer coding, Strong organizational and time-management, Discretion and respect for patient confidentiality (HIPAA compliance).

Qualifications

• One or more of the following certifications required or preferred: CPC (Certified Professional Coder) – AAPCC, CCS-P (Certified Coding Specialist – Physician-based) – AHIMA, CPC-A, COC, or equivalent credential considered with relevant experience.

Skills

• Strong understanding of ICD-10-CM, CPT, and HCPCS Level II coding systems.
• Familiarity with E/M (Evaluation & Management) coding and documentation guidelines.
• Experience with electronic health records (EHR) and practice management systems preferred.

Benefits

Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.