Certified Coder

Key Responsibilities

• Review and audit charge encounters/tickets for correct CPT, ICD-10, and HCPCS coding across multiple facilities and systems
• Assist with pre- and post-audits while maintaining compliance with payer reimbursement policies and government regulations
• Monitor audit progress and communicate with coding leadership
• Maintain required annual CEUs and active certification
• Abstract and code patient encounters, including diagnostic and procedural information
• Analyze medical records and identify documentation deficiencies
• Serve as a coding resource and subject matter expert to leadership and peers
• Verify documentation supports diagnosis, procedure, and treatment results
• Audit clinical documentation and coded data for reimbursement and reporting purposes
• Identify discrepancies, billing issues, and potential quality concerns
• Research and recommend corrective actions to prevent future coding errors
• Prepare and submit clean claims to insurance companies via electronic and paper methods
• Assist with claim resolution, denials, and collections activities
• Review secondary and tertiary insurance billing, EOBs, and supporting documentation
• Maintain daily billing queues and follow up on claim issues related to coding workflow

Qualifications

• High School Diploma or GED required
• 3+ years of progressive experience in medical coding/reimbursement
• Active CPC or CCS certification
• Strong knowledge of ICD-10-CM, CPT, HCPCS, Medicare, Medicaid, and payer billing guidelines
• Experience with AdvancedMD and NextGen preferred
• Knowledge of payer requirements, insurance verification, referrals, and authorizations
• Experience using payer portals such as Availity, NaviNet, and Orthonet preferred
• Proficiency with Microsoft Word, PowerPoint, Excel, and general data entry systems
• Strong written and verbal communication skills
• Detail-oriented, professional, organized, and able to multitask in a high-volume environment

Benefits and Perks

• Medical, dental, and vision coverage
• Employee Assistance Program (EAP)
• Life and long-term disability insurance
• 401(k) with employer match
• Paid time off starting at 15 days per year
• Paid parental leave
• Tuition reimbursement