The RCM Coding Specialist is responsible for the accurate assignment of ICD-10-CM, CPT, and HCPCS codes based on clinical documentation to ensure compliant billing, timely claim submission, and optimal reimbursement. This role supports pre-claim workflows by identifying and resolving documentation gaps, validating medical necessity, and ensuring clean claim submission to reduce denials.
The position collaborates cross-functionally with billing, AR, clinical, and operational teams to resolve coding and data deficiencies while maintaining compliance with payer guidelines and regulatory requirements. In addition to coding responsibilities, the role performs data analysis to identify trends, improve data quality, and drive revenue cycle performance.
Performs other duties as assigned.
- 3–5+ years of experience in U.S. medical coding; laboratory experience preferred
- Certified coder designation required (CPC, CCS, CCA, CIC, or equivalent through AAPC or AHIMA)
- Healthcare-related degree or equivalent experience
- Strong knowledge of ICD-10-CM, CPT, HCPCS coding systems, modifiers, and NCCI edits
- Understanding of medical necessity requirements and payer-specific guidelines
- Knowledge of Medicare, Medicaid, and commercial payer regulations
- Experience with EMR/EHR systems, practice management systems, and payer portals
- Strong attention to detail and high level of accuracy
- Analytical and problem-solving skills with the ability to identify root causes and trends
- Ability to translate complex clinical and coding data into actionable insights
- Strong organizational skills with the ability to manage multiple priorities and deadlines
- Excellent verbal and written communication skills
- Ability to work independently and collaboratively across cross-functional teams
- Adaptability and ability to work in a fast-paced, evolving environment
- Commitment to maintaining confidentiality and compliance with HIPAA standards
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Location
Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago