Health Information and Coding Specialist II

The Medical Coder ensures accurate coding and billing capture for primary care, specialty, and ancillary services. This role assigns ICD-10-CM and CPT codes to support timely and compliant reimbursement, ensuring adherence to federal, legal, and payer regulations. Responsibilities include responding to coding inquiries, performing post submission reviews, supporting denial management, and coordinating corrected claims or appeals with reimbursement teams to optimize revenue recovery.

Ensure accurate ICD-10-CM and CPT coding with zero errors. Validate diagnosis and treatment documentation, query providers for clarification. Stay current on coding guideline updates and communicate changes, trends, and payer issues to leadership. Use auditing tools to monitor accuracy, identify trends, and drive corrective action. Meet productivity benchmarks and maintain active professional coding certification.

Strong analytical, problem-solving, and decision-making skills. Clear, adaptable communication and effective listening. High integrity, accountability, adaptability, and attention to detail. Patient-focused, compassionate, and compliant with ethical standards. Proactive, results-driven, quality-oriented, and collaborative team member. Demonstrates continuous learning, initiative, and technical proficiency.

Associate’s degree or equivalent. 1+ year clinical and/or Medicare Risk Adjustment experience; quality improvement experience preferred. Healthcare and insurance industry experience. Knowledge of clinical standards, preventive care, and office-based procedures. Certified Professional Coder (CPC or equivalent). Show proficiency in Microsoft Excel, Word, Outlook, and Electronic Medical Record systems.

Primarily sedentary with occasional standing, walking, and lifting (up to 25 lbs). Requires fine motor skills, visual acuity, and standard office environment tolerance.