Senior Medical Coding Specialist

Senior Medical Coding Specialist

We are seeking a Senior Medical Coding Specialist to join our Clinical Operations team. This role is crucial in ensuring that the services we support are backed by accurate, compliant, and clinically sound documentation and coding.

• Audit behavioral health documentation and coding (ICD-10-CM and CPT) for accuracy, compliance, and completeness.
• Deliver actionable feedback to providers through 1:1 remediation meetings, educating on coding and documentation guidelines (e.g., coding based on medical decision making (MDM) for outpatient Evaluation and Management services).
• Serve as a subject matter expert by answering coding-related questions to support internal teams and create processes.
• Contribute to provider education efforts, including drafting content, identifying documentation gaps, and advising on clinical documentation standards.
• Provide insights on coding trends, identify risk areas, and recommend improvements to tooling, product, and training.
• Collaborate with cross-functional partners on initiatives and enhancements regarding billing code guardrails.
• Stay current with evolving coding guidelines, payer rules, and industry standards through continuing education and independent learning.

About the role

Headway is building a new mental healthcare system that is accessible, effective, and built to scale. Our mission is to fix the biggest barrier to care: insurance. We automate the administrative work, serve over 1 million patients, and are committed to providing the best tools for therapists to run their practices.

Responsibilities

• Audit behavioral health documentation and coding (ICD-10-CM and CPT) for accuracy, compliance, and completeness.
• Deliver actionable feedback to providers through 1:1 remediation meetings, educating on coding and documentation guidelines.
• Serve as a subject matter expert by answering coding-related questions to support internal teams and create processes.
• Contribute to provider education efforts, including drafting content, identifying documentation gaps, and advising on clinical documentation standards.
• Provide insights on coding trends, identify risk areas, and recommend improvements to tooling, product, and training.
• Collaborate with cross-functional partners on initiatives and enhancements regarding billing code guardrails.
• Stay current with evolving coding guidelines, payer rules, and industry standards through continuing education and independent learning.

Requirements

• Licensure as a Certified Professional Coder (CPC).
• 2+ years of experience in outpatient or professional services coding within a behavioral health setting.
• The ability to balance supportive coaching and enforcing provider policies regarding payer standards and compliance regulations.
• Previously educated providers on medical decision making (MDM) for outpatient Evaluation and Management services.
• CPMA certification (nice to have) or strong auditing experience.
• A strong grasp of ICD-10, CPT, and HCPCS coding guidelines and the documentation requirements.
• Able to communicate clearly and empathetically, especially when educating providers or discussing sensitive feedback.
• Comfort working independently in a fast-paced, digital environment.
• Tech-savvy: able to navigate Google Workspace, Zoom, and EMR platforms or willing to learn.
• Energetic about working cross-functionally and driving quality at scale in a tech-forward setting.

Qualifications

• Strong analytical and auditing skills.
• Understanding of mental health diagnoses and documentation requirements.
• Experience with coding based on medical decision making (MDM) for outpatient Evaluation and Management services.
• Knowledge of ICD-10, CPT, and HCPCS coding guidelines and documentation requirements.
• Ability to communicate clearly and empathetically, especially when educating providers or discussing sensitive feedback.
• Comfort working independently in a fast-paced, digital environment.
• Tech-savvy: able to navigate Google Workspace, Zoom, and EMR platforms or willing to learn.
• Energetic about working cross-functionally and driving quality at scale in a tech-forward setting.

Skills

• Strong analytical and auditing skills.
• Understanding of mental health diagnoses and documentation requirements.
• Experience with coding based on medical decision making (MDM) for outpatient Evaluation and Management services.
• Knowledge of ICD-10, CPT, and HCPCS coding guidelines and documentation requirements.
• Ability to communicate clearly and empathetically, especially when educating providers or discussing sensitive feedback.
• Comfort working independently in a fast-paced, digital environment.
• Tech-savvy: able to navigate Google Workspace, Zoom, and EMR platforms or willing to learn.
• Energetic about working cross-functionally and driving quality at scale in a tech-forward setting.

Benefits

• Compensation range: $76,160 - $112,000 based on qualifications and experience.
• Comprehensive benefits package including medical, dental, vision coverage, HSA/FSA, 401K, work-from-home stipend, therapy reimbursement, parental leave, holiday break, and training and professional development.
• Commitment to diversity and inclusion.
• Participation in E-Verify.