Certified Coding Specialist

firstsourc•Remo, VA

3d•Onsite

About The Position

The Certified Coding Specialist will be responsible for reviewing and coding claims prior to submission to payers, as well as reviewing denied claims to identify and resolve coding-related issues. This role requires a strong understanding of ICD-10-CM/PCS, CPT, HCPCS codes, modifiers, and prospective payment systems. The specialist will collaborate with various internal and external teams to ensure accurate coding, compliance with regulations, and effective denial prevention and resolution. Responsibilities may vary based on experience and client needs, encompassing roles such as Coding Denials Specialist or a general Coding Specialist.

Requirements

Certified Professional Coder (CPC) and/or Certified Outpatient Coder (COC) credentialed from the American Academy of Professional Coders (AAPC) obtained before hire or job transfer. All specialties accepted.
OR: Certified Coding Specialist (CCS) and/or Certified Inpatient Coder (CIC) credentialed from the American Health Information Management Association (AHIMA) obtained before hire or job transfer.
OR: Certified Billing and Coding Certification from the National Health Career Association with a commitment to obtain one of the above within 6 months of job offer.
Experience in E&M Specialty Coding - Outpatient, Inpatient, observation, Critical care facilities using ICD, Modifiers, CPT, HCPCS codes, applicable to role.
0-5+ years of experience in E&M inpatient and/or outpatient medical record review, coding and reimbursement, preferred 3 years experience.
Strong knowledge of ICD-10 CM/PCS and CPT coding and prospective payment systems.
Proficiency with Microsoft Windows operating systems and Office applications, such as Word, Excel, PowerPoint.
Able to work well with minimal supervision.
Able to communicate clearly both written and verbally.
Able to generate reports for management review that present results in a clear manner.
Able to meet deadlines and respond well to frequent changes in priorities.
Adept in handling changes in coding / billing regulation and requirements.
Able to maintain positive and productive relationships with internal and external teams and customers.
Able to work independently and be a self-starter.

Nice To Haves

Inpatient coder required to have the CIC or the CCS.
Outpatient or professional coder would be expected to have a Certified Professional Coder (CPC) and/or a Certified Outpatient Coder (COC) designation.

Responsibilities

Review payer denials to identify coding-related issues (ICD-10-CM/PCS, CPT, HCPCS, modifiers, DRG/APC assignments).
Perform root cause analysis on denials related to medical necessity, bundling, edits, and documentation.
Correct coding errors and rebill claims or recommend corrections to client in accordance with payer policies and regulatory guidelines.
Collaborate with client teams (CDI, providers, billing, and revenue integrity) to resolve documentation and coding issues.
Submit appeals with appropriate clinical justification and coding support.
Track, trend, and report denial patterns and recommend process improvements.
Ensure compliance with official coding guidelines, NCCI edits, LCD/NCDs, and payer-specific rules.
Maintain productivity and quality standards for denial resolution.
Participate in audits, education, and feedback initiatives.
Support training for coders and clinical staff on denial prevention strategies.
Use Encoder, billing, and EMR systems to research and resolve accounts.
Maintain accurate documentation of actions taken on each denial.
Review inpatient, outpatient, ED, and/or professional fee medical records to assign accurate ICD-10-CM/PCS, CPT, and HCPCS codes.
Apply official coding guidelines, payer rules, NCCI edits, and facility policies.
Ensure codes reflect complete, clear, and compliant documentation.
Abstract data elements required for billing, quality, and reporting.
Query providers when documentation is unclear, incomplete, or conflicting.
Meet established productivity and quality standards.
Participate in internal and external audits and implement feedback.
Maintain compliance with HIPAA and all regulatory requirements.
Stay current with coding updates, payer changes, and regulatory guidance.
Collaborate with CDI, billing, and revenue integrity teams.
Support education and process improvement initiatives.
Use encoder, EMR, and billing systems efficiently and accurately.
Maintain detailed and timely account documentation.
Contribute to the development of educational and training opportunities for staff.
Create update tracker and responsible for updating the team on trends and changes.
Provide feedback & coaching on common error scenarios.
Prepare reports for leadership review and identify trends.