Medical Coder

The Medical 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 prior to 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 Life

• 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 services and diagnoses
• Ensure diagnosis codes meet local and national medical necessity guidelines
• Use internal coding resources, payer guidelines, and reference materials to ensure accurate and compliant coding
• Follow HIPAA regulations and maintain 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 requirements
• Perform other duties as assigned