The Coding Specialist is responsible for independently reviewing, analyzing, and resolving assigned front-end scrubs and denied claims to ensure accurate and timely claim payment. This role focuses on identifying and correcting coding-related issues prior to claim submission, resubmitting corrected claims, and appealing denied claims while applying established coding guidelines, payer requirements, and organizational policies.
The position works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. It requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.
A Day in the Life
- Averages 10 front-end holds/denials per hour
- Reviews coding and resubmits corrected claims to insurance
- Creates appeal letters/forms with medical documentation
- Maintains a minimum of 92% coding accuracy
- Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment
- Reviews medical records and applicable documentation to determine appropriate codes for documented services and diagnoses
- Ensures diagnosis codes meet local and national medical necessity guidelines
- Uses internal coding resources, payer guidelines, and reference materials to ensure accurate and compliant coding
- Follows HIPAA regulations and maintains privacy and confidentiality
- Stays current on laws, regulations, payer policies, and industry guidance affecting coding practices
- Independently resolves assigned front-end claim holds
- Participates in department meetings, one-on-one meetings, and mentorship meetings with the Coding Team Lead
- Escalates client trends and coding questions to the Coding Manager
- Maintains required CEU credits
- Performs other duties as assigned
- Current AAPC or AHIMA coding certification held for at least 3 years
- Minimum of 3+ years of professional coding experience
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and Medicare reimbursement guidelines
- Experience reviewing front-end coding errors before insurance submission
- Experience correcting coding issues from insurance denials
- Experience submitting corrected claims and appeals
- Experience with insurance guidelines and EOBs
- Strong grammar, usage, and professional documentation skills
- Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues
- Ability to read, interpret, and apply policies, procedures, laws, and regulations
- Ability to accurately interpret medical documentation, clinical terminology, and procedures
- Demonstrated ability to exercise independent judgment in coding and claim resolution
- Excellent written and verbal communication skills
- Strong commitment to confidentiality and safeguarding protected health information
- Prior experience in a medical billing environment with strict HIPAA compliance
- Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams
- 20 days of fixed paid time off per year, plus company holidays
- Best-in-class parental leave
- Monetary incentives and company-wide recognition
- Medical, dental, and vision insurance
- 100% company-paid short- and long-term disability insurance
- 100% company-paid basic life insurance
- Optional discounted legal aid and pet insurance
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago