Remote Medical Coder (United States)

Key Responsibilities

• Assign accurate ICD-10-CM, CPT, and HCPCS codes from provider documentation and clinical records
• Apply official guidelines, payer policies, NCCI edits, and modifier rules to improve clean-claim rates
• Review charts for specificity, medical necessity, and documentation gaps; escalate to CDI/provider queries as needed
• Perform coding QA reviews to support audit readiness, compliance, and internal standards
• Support denial prevention and resolution by analyzing claim edits and root causes
• Maintain productivity and accuracy targets and document coding rationale
• Protect PHI and follow HIPAA/security best practices in a fully remote environment
• Collaborate with billing, AR, compliance, and clinical teams to improve revenue cycle performance

Required Qualifications

• 3+ years of recent medical coding experience (professional fee and/or facility)
• Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and E/M guidelines
• Experience with encoder/grouper tools, EHR workflows, and claim edit concepts (e.g., NCCI)
• Working knowledge of HIPAA, documentation standards, and audit expectations
• Ability to work independently in a remote, metric-driven environment

Preferred Qualifications

• Active credential such as CPC, CCS, CIC, COC, or CRC (role-aligned)
• HCC risk adjustment/RAF validation experience
• Specialty coding experience (e.g., ED, radiology, surgery, cardiology)
• Experience with coding audits, second-level reviews, and coder coaching
• Familiarity with denial management, payer policy research, and appeals support