Medical Coding Specialist – I

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

📋 Description

• The Medical Coder is tasked with independently reviewing, analyzing, and resolving all front-end claims assigned to ensure they are submitted accurately and promptly.

• This role emphasizes the identification and rectification of coding-related issues before claims are transmitted, adhering to established coding standards, payer requirements, and organizational policies.

• The Medical Coder collaborates closely with revenue cycle partners to minimize claim rejections, enhance clean claim rates, and facilitate efficient reimbursement processes.

• This position demands a keen attention to detail, foundational coding expertise, and the capability to work autonomously in a dynamic environment.

• Handles an average of 10 front-end holds per hour.

• Achieves a minimum of 90% coding accuracy.

• Assigns ICD-10-CM and CPT codes with the necessary modifiers for services rendered in the professional fee setting.

• Reviews medical records and relevant documentation to identify appropriate codes for the services and diagnoses documented.

• Ensures all diagnosis codes comply with local and national medical necessity criteria.

• Employs internal coding resources, payer guidelines, and reference materials to guarantee accurate and compliant coding for all assigned services.

• Adheres to all HIPAA regulations, maintaining the highest standards of privacy and confidentiality.

• Keeps abreast of current laws, regulations, payer policies, and industry guidance that influence compliant coding practices.

• Independently reviews and resolves all assigned front-end claim holds.

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

• Reports identified client trends to the assigned Coding Team Lead.

• Escalates any coding-related inquiries to the assigned Coding Team Lead for further guidance and clarification.

• Completes and maintains all CEU requirements.

• Performs additional duties or tasks as required.

⛳️ Requirements

• Must possess a current AAPC or AHIMA Certification with a minimum of 3 years of experience.

• Strong understanding of CPT, ICD-10-CM, medical terminology, anatomy, physiology, and state and federal Medicare reimbursement guidelines.

• Familiarity with proper English grammar, usage, and professional documentation practices.

• Ability to research and analyze data, draw logical conclusions, and address coding or documentation challenges.

• Capability to read, interpret, and implement policies, procedures, laws, and regulations.

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

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

• Excellent written and verbal communication skills, including the ability to create reports, clarify documentation requirements, and foster collaborative working relationships with physicians and staff.

• Strong dedication to maintaining confidentiality and protecting sensitive health information.

• Prior experience in a medical billing setting with strict compliance to HIPAA standards.

• 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