Certified Medical Coder

The Coding Specialist is responsible for independently reviewing, analyzing, and resolving assigned front-end claims to ensure accurate and timely claim submission. The role focuses on identifying and correcting coding-related issues before claim transmission, applying established coding guidelines, payer requirements, and organizational policies. This position works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes.

A Day in the Role

• Average 10 front-end holds per hour
• Maintain a minimum of 90% coding accuracy
• Assign ICD-10-CM and CPT codes with appropriate modifiers for professional fee services
• Review medical records and supporting documentation to determine appropriate codes for documented services and diagnoses
• Ensure diagnosis codes meet local and national medical necessity guidelines
• Use internal coding resources, payer guidelines, and reference materials to support accurate and compliant coding
• Follow HIPAA regulations and maintain privacy and confidentiality
• Stay current on laws, regulations, payer policies, and industry guidance affecting coding practices
• Independently review and resolve assigned front-end claim holds
• Participate in department, one-on-one, and mentorship meetings with the Coding Team Lead
• Escalate client trends and coding questions to the Coding Team Lead as needed
• Complete continuing education unit requirements
• Perform other duties as assigned