Medical Coding Specialist

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

📋 Description

• Conduct independent reviews, analyses, and resolutions of assigned front-end scrubs, holds, and denied claims.

• Process an average of 10 front-end holds/denials each hour.

• Evaluate coding accuracy and resubmit corrected claims to insurance providers.

• Draft appeal letters/forms accompanied by medical documentation.

• Maintain a coding accuracy rate of at least 92%.

• Assign ICD-10-CM and CPT codes, including appropriate modifiers, for professional-fee services.

• Examine medical records and documentation to identify suitable codes for services and diagnoses.

• Ensure that diagnosis codes comply with local and national medical necessity standards.

• Utilize internal coding resources, payer guidelines, and reference materials for precise and compliant coding.

• Adhere to HIPAA regulations, ensuring privacy and confidentiality are upheld.

• Stay updated on laws, regulations, payer policies, and industry standards.

• Engage in department meetings, one-on-one sessions, and mentorship with the designated Coding Team Lead.

• Report client trends and coding inquiries to the designated Coding Manager.

• Fulfill and maintain all CEU requirements.

• Execute other assigned tasks as needed.

⛳️ Requirements

• AAPC or AHIMA Coding Certification held for a minimum of 3 years is required.

• At least 3+ years of professional coding experience is necessary.

• Comprehensive knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and Medicare reimbursement guidelines at both state and federal levels.

• Previous experience in identifying front-end coding errors prior to insurance submission.

• Experience in reviewing and rectifying coding issues stemming from insurance denials.

• Proven track record in submitting corrected claims and appeals.

• Familiarity with insurance guidelines and Explanation of Benefits (EOBs).

• Proficient in English grammar, usage, and standards for professional documentation.

• Capable of researching and analyzing data, drawing logical conclusions, and addressing coding or documentation challenges.

• Ability to read, interpret, and apply policies, procedures, laws, and regulations effectively.

• Skilled in accurately reading and interpreting medical documentation, clinical terminology, and recorded procedures.

• Proven ability to exercise independent judgment in coding and claim resolution.

• Exceptional written and verbal communication skills, including report preparation, documentation clarification, and fostering collaborative relationships with physicians and staff.

• Strong commitment to maintaining confidentiality and protecting health information.

• Previous experience in a medical billing environment with strict adherence to HIPAA compliance requirements.

• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams).

• Employment eligibility in the United States, verified through the E-Verify program for newly hired U.S.-based employees.

🏝️ Benefits

• 20 days of fixed time off annually, in addition to company holidays.

• Generous parental leave.

• Financial incentives and company-wide recognition for impact and dedication.

• Comprehensive medical, dental, and vision insurance.

• 100% company-paid short- and long-term disability insurance.

• 100% company-paid basic life insurance.

• Discounted legal aid services.

• Pet insurance options available.