Certified Coder

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess medical record documentation and claim information before submission to guarantee precise assignment of ICD-10-CM, CPT, and HCPCS codes, thereby facilitating suitable reimbursement and adherence to regulatory standards.

• Examine and evaluate coding-related claim denials, underpayments, and payer audit results to pinpoint root causes and suggest corrective measures that enhance reimbursement results.

• Investigate payer policies, coding guidelines, and medical record documentation to assist in denial appeals, claim corrections, and reconsideration requests when applicable.

• Work in conjunction with billing and operational teams to address coding-related claim challenges, minimize recurring denials, and boost first-pass claim acceptance rates.

• Track coding, billing, and denial trends; compile reports and collaborate with leadership and operational teams to implement process enhancements, coding edits, and workflow improvements that foster compliance and optimize reimbursement.

• Remain updated on modifications to coding regulations, reimbursement methodologies, payer policies, and industry best practices through continual education and professional growth.

⛳️ Requirements

• A minimum of two years of experience in medical record coding and denial management.

• In-depth knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, medical terminology, anatomy and physiology, along with relevant payer, regulatory, and reimbursement criteria.

• Proficiency in coding encoder software, electronic medical record (EMR) systems (experience with EPIC is preferred but not mandatory), Microsoft Office applications, and other healthcare technology platforms.

• Understanding of Medicare, Medicaid, and commercial payer policies, encompassing documentation, coding, reimbursement, and compliance obligations.

• Strong analytical and problem-solving capabilities with the ability to research coding regulations, interpret payer policies, identify denial root causes, and devise effective solutions.

• Skill in reviewing, interpreting, and applying complex medical documentation, coding guidelines, policies, procedures, laws, and regulations.

• Experience in reviewing and resolving coding-related denials, underpayments, and payer audit findings is preferred.

• Capability to exercise sound independent judgment while maintaining a high degree of accuracy, attention to detail, and professionalism.

• Exceptional written and verbal communication abilities.

• Strong interpersonal skills with the capacity to cultivate collaborative relationships with providers, operational leaders, and revenue cycle teams.

• Proven commitment to confidentiality, ethical conduct, and adherence to HIPAA and organizational policies.

• Certified Professional Coder (CPC) credential from the American Academy of Professional Coders (AAPC).

• Certified Coding Specialist (CCS) credential from the American Health Information Management Association (AHIMA).

• Registered Health Information Technician (RHIT) designation from the American Health Information Management Association (AHIMA).

🏝️ Benefits

• Competitive base compensation

• Health benefits