Certified Coder, CPC/CCS

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Conduct reviews and audits of charge encounters/tickets to ensure accurate CPT, ICD-10, and HCPCS coding across various facilities and systems.

• Provide assistance with both pre- and post-audits while adhering to payer reimbursement policies, government regulations, and Medicare/CMS guidelines.

• Track audit progress and report findings to the Coding Compliance Manager.

• Maintain necessary annual CEUs and hold an active certification.

• Code and abstract patient encounters, including diagnostic and procedural elements, reportable information, and complications.

• Examine medical records to identify any documentation deficiencies.

• Act as a coding resource and subject matter expert for RCM leadership, colleagues, providers, and departmental staff.

• Review and confirm documentation supporting diagnoses, procedures, and treatment outcomes.

• Audit clinical documentation and coded data to ensure validation for services provided.

• Assign codes for reimbursement, research, and regulatory compliance purposes.

• Detect discrepancies, potential quality-of-care concerns, and billing problems.

• Investigate and resolve coding discrepancies as well as rejected or denied claims.

• Uphold patient confidentiality and adhere to HIPAA regulations.

• Code, prepare, and submit clean claims to insurance companies both electronically and via paper.

• Assist in resolving healthcare claims and ensuring appropriate reimbursement collection.

• Review and bill secondary and tertiary insurance claims.

• Manage daily billing queues and follow up on claim issues related to coding workflows.

• Oversee daily workflow in a production setting and complete tasks within set deadlines.

• Enhance coding and billing knowledge through ongoing education and professional publications.

• Participate in mandatory virtual meetings via Teams or Zoom.

• Perform other assigned responsibilities.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 3 years of progressive experience in medical coding/reimbursement.

• Advanced understanding of ICD-10-CM, CPT, and HCPCS coding.

• Familiarity with IHS coding conventions.

• Experience with AdvancedMD and NextGen databases is highly preferred.

• Knowledge of insurance payer requirements, benefit coverage, referrals, and authorizations.

• Understanding of insurance billing and collection guidelines, including HMO/PPO, Medicare, Medicaid, and third-party payers.

• Awareness of LCDs, payer billing guidelines, and medical policies.

• Familiarity with online payer portals such as Availity, NaviNet, and Orthonet.

• Proficiency in computer systems, data entry, spreadsheet applications, and MS Office, including Word, PowerPoint, and Excel.

• Knowledge of healthcare legislation, regulations, and CMS guidelines.

• Ability to multi-task, meet deadlines, work independently, take the initiative, and collaborate effectively.

• Strong written and verbal communication, organizational, and customer service skills.

• Detail-oriented self-starter with a robust work ethic.

• Capability to maintain confidentiality and comply with HIPAA regulations.

• Possession of an active coding certification and completion of required annual CEUs.

🏝️ Benefits

• Medical, Dental, and Vision coverage.

• Employee Assistance Program (EAP).

• Life & Long-Term Disability Insurance.

• 401(k) with employer match.

• Paid time off starting at 15 days per year.

• Paid parental leave.

• Tuition reimbursement.