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Medical Coding Specialist – I
Job Description:
- The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission.
- This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies.
- The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes.
- This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.
- Averages 10 front-end holds per hour.
- Maintains a minimum of 90% coding accuracy.
- Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment.
- Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses.
- Ensures all diagnosis codes meet local and national medical necessity guidelines.
- Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services.
- Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.
- Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices.
- Independently reviews and resolves all assigned front-end claim holds.
- Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead.
- Escalates identified client trends to the assigned Coding Team Lead.
- Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification.
- Maintains and completes all CEU requirements.
- Performs other duties or tasks as assigned.
Requirements:
- Must hold a current AAPC or AHIMA Certification for a minimum of 3 years.
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
- Familiarity with proper 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 ability to exercise independent judgment in coding and claim resolution.
- Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff.
- Strong commitment to maintaining confidentiality and safeguarding protected health information.
- Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements.
- Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams).
- Minimum of 3+ years of professional coding experience.
Benefits:
- Private Health Insurance
- Pension Plan
- Paid Time Off
- Work From Home
- Training & Development
- Performance Bonus
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Public Holidays)
- Family Leave (Maternity, Paternity)
- Short Term & Long Term Disability
- Free Food & Snacks
- Wellness Resources
