The Medical Coder, RCM is responsible for ensuring coding accuracy and claim readiness prior to submission, focusing on resolving missing or invalid order and documentation elements that cause rejections, denials, and delayed reimbursement. This role works closely with RCM front-end teams and the broader RCM organization to enhance clinical defensibility and coding integrity through standardized workflows, proactive quality reviews, and documentation readiness.
The role aims to strengthen pre-claim coding and documentation integrity to reduce avoidable rework and improve reimbursement outcomes, benefiting patients, providers, Client Services, Market Access partners, and Revenue Cycle operations by improving claim quality and reducing delays.
Success is measured by improved front-end completeness (e.g., fewer missing ICD-10, demographic, or insurance elements), improved clean-claim readiness, and fewer coding- or documentation-related denials.
Key responsibilities include:
- Reviewing orders and documentation to confirm accurate, compliant ICD-10 and CPT/HCPCS coding for claim submission.
- Identifying missing or incomplete critical claim elements and driving timely remediation.
- Confirming documentation and coding elements meet payer requirements prior to claim submission and escalating gaps.
- Executing coding-focused quality checks and proactive audits to detect trends and reduce denials.
- Contributing to creation and maintenance of standardized templates and checklists.
- Partnering with front-end operations and clinical teams to reduce missing billing information and rework.
- Collaborating cross-functionally to translate payer requirements into scalable practices.
- Supporting operational reporting by tracking recurring gap themes affecting claim quality.
- Aligning work to key RCM performance metrics to reduce bottlenecks.
- Performing other job-related duties as assigned.
Qualifications:
Required:
- High school diploma or equivalent; additional education in health sciences or related field preferred.
- Working knowledge of ICD-10-CM and CPT/HCPCS coding concepts as applied to claim-submission readiness.
- Ability to identify missing or invalid claim-critical data and drive resolution via cross-functional coordination.
Preferred:
- Professional coding certification (AAPC/AHIMA or equivalent).
- Experience supporting pre-claim quality, audits, or denial prevention in a high-volume healthcare revenue cycle environment.
Competencies:
- Coding integrity and compliance mindset
- Attention to detail and pre-claim quality focus
- Analytical problem solving
- Cross-functional execution and follow-through
- Clear communication
Physical demands include extended periods of sitting and computer use, frequent use of hand and finger dexterity for typing and data entry. Work environment may be onsite, hybrid, or remote.
- High school diploma or equivalent; additional health sciences education preferred.
- Working knowledge of ICD-10-CM and CPT/HCPCS coding for claims.
- Ability to identify and remediate missing claim-critical elements.
- Preferred professional coding certification (AAPC/AHIMA or equivalent).
- Preferred experience in pre-claim quality, audits, or denial prevention in healthcare revenue cycle.
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago