The Medical Coder is responsible for independently reviewing, analyzing, and resolving assigned front-end scrubs and denied claims to support accurate and timely claim payment. This role focuses on identifying and correcting coding-related issues prior to claim submission, resubmitting corrected claims, or appealing denied claims in accordance with established coding guidelines, payer requirements, and organizational policies.
The Coding Specialist partners closely with revenue cycle teams to reduce claim rejections, support clean claim rates, and improve reimbursement efficiency. The role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.
A Day in the Life
- Average 10 front-end holds/denials per hour
- Review coding and resubmit corrected claims to insurance
- Create appeal letters and forms with medical documentation
- Maintain a minimum of 92% coding accuracy
- Assign ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment
- Review medical records and supporting documentation to determine appropriate codes for documented services and diagnoses
- Ensure all 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 uphold privacy and confidentiality standards
- Stay current on laws, regulations, payer policies, and industry guidance impacting compliant coding practices
- Independently resolve assigned front-end claim holds
- Participate in department, one-on-one, and mentorship meetings with the Coding Team Lead
- Escalate identified client trends and coding questions to the Coding Manager
- Complete continuing education unit requirements
- Perform other duties as assigned
Qualifications
- Current AAPC or AHIMA coding certification held for a minimum of 3 years
- Minimum of 3+ years of professional coding experience
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines
- Prior experience reviewing front-end coding errors before submission to insurance
- Prior experience correcting coding related to insurance denials
- Prior experience submitting corrected claims and appeals
- Prior experience with insurance guidelines and EOBs
- Strong command of English grammar, usage, and professional documentation standards
- 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 read and interpret medical documentation, clinical terminology, and documented procedures
- Demonstrated 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 requirements
- Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams
Benefits and Perks
- 20 days of fixed paid time off per year, plus company holidays
- Generous parental leave policy
- Monetary incentives and company-wide recognition programs
- 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
Senior
Remote work allowed
No
Posted
2 weeks ago