Coding Specialist

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

📋 Description

• Assign precise ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes for outpatient encounters.

• Implement appropriate modifiers to ensure accurate reimbursement while adhering to NCCI and global edits.

• Code for clinic E&M, outpatient surgery, observation services, emergency department visits, infusion/injection procedures, diagnostic imaging, and ancillary services.

• Examine clinical documentation to verify medical necessity and justify code selection.

• Submit compliant, non-leading physician queries when documentation is ambiguous, incomplete, or contradictory.

• Apply correct sequencing of primary and secondary diagnoses and appropriately link diagnoses to procedures.

• Detect and report charge capture inaccuracies, missing charges, and documentation gaps.

• Uphold client-defined coding accuracy standards and meet daily productivity benchmarks.

• Record coding rationale and query actions in encoder, EHR, or coding workflow software.

• Resolve coding-related claim rejections and denials through analysis, corrected codes or modifiers, supporting documents, and claims follow-up.

• Keep abreast of current coding best practices, payer policies, and regulatory updates.

• Stay informed about annual updates for ICD-10-CM, CPT, HCPCS, MPFS, and payer policies.

• Ensure compliance with HIPAA, CMS regulations, and fraud/abuse laws, including the False Claims Act.

• Shift coding assignments across various ambulatory specialty areas based on client demands and individual strengths.

⛳️ Requirements

• High School Diploma or GED required.

• At least 1 year of medical coding experience.

• Multi-specialty coding experience is preferred.

• Familiarity with split/shared visit, incident-to, and time-based E&M coding under current CMS guidelines is preferred.

• Previous experience with coding audits, formal appeals writing, or responding to external payer audits is preferred.

• Current coding certification from AAPC (CPC, COC) or AHIMA (CCS, CCS-P, RHIA, RHIT) is preferred.

• Proficient in ICD-10-CM, CPT, HCPCS, and modifier regulations.

• Knowledge of NCCI edits, MUE edits, global edits, and LCD/NCD policies is essential.

• Skilled in using encoder tools (3M, TruCode, Optum EncoderPro, or similar) and EHR, PMS systems.

• Strong grasp of clinical documentation and the capability to draft compliant, non-leading physician queries.

• Exceptional attention to detail and ability to maintain accuracy under productivity demands.

• Ability to forge effective working relationships with team members, supervisors, managers, clients, and providers.

• Capable of prioritizing workload and managing multiple responsibilities in an organized, efficient, and effective manner.

• Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse laws.

• Must currently reside in the United States, as indicated by the application question.

🏝️ Benefits

• Access to a 401(k) Retirement Savings Plan.

• Comprehensive Medical, Dental, and Vision Coverage.

• Paid Time Off.

• Paid Holidays.

• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.

• Flexible work hours when feasible.

• A genuine sense of belonging to a dynamic and growing organization.