Certified Coding Specialist

firstsourc•Remo, VA

About The Position

The Certified Coding Specialist is responsible for reviewing medical documentation and assigning accurate diagnosis and procedure codes for inpatient and outpatient facility services while ensuring compliance with ICD-10-CM/PCS, CPT, HCPCS, payer policies, and regulatory guidelines. This position also supports coding-related claim denials and front-end claim edits/rejections by identifying coding opportunities prior to claim submission and resolving post-adjudication coding issues. The ideal candidate possesses strong analytical skills, attention to detail, and the ability to work collaboratively with providers, CDI, billing, and revenue cycle teams to maximize coding accuracy and reimbursement.

Requirements

Active CPC, COC, CCS, or CIC certification.
2+ years of inpatient and/or outpatient facility coding preferred.
Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, modifiers, DRGs/APCs.
Knowledge of NCCI edits, LCD/NCDs, CMS regulations, and Official Coding Guidelines.
Excellent communication and Microsoft Office skills.
Ability to prioritize work, meet deadlines, and work independently.

Nice To Haves

Experience coding both inpatient and outpatient facility accounts.
Experience reviewing coding-related denials and appeals.
Experience resolving front-end claim edits and payer rejections.
Knowledge of Medicare, Medicaid, and commercial payer reimbursement guidelines.
Experience using coding encoders and electronic medical record systems (e.g., 3M, TruCode, Epic, Meditech, Cerner).
Knowledge of DRG, APC, NCCI edits, and medical necessity guidelines.
Inpatient Facility Coding
Outpatient Facility Coding
Emergency Department Coding
Observation
Same-Day Surgery
Infusion & Injection Coding
Medical Necessity Reviews
DRG Validation
Revenue Integrity
Coding Denials
Claim Rejections

Responsibilities

Review inpatient, outpatient, ED, observation, surgery, and ancillary records.
Assign accurate ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and modifier codes.
Review coding edits and work queues prior to claim submission.
Validate documentation supports code assignment.
Query providers when documentation is incomplete or conflicting.
Maintain productivity and quality standards.
Participate in coding audits and education.
Review coding-related payer denials.
Perform root cause analysis.
Correct coding errors and recommend appeals.
Review denials involving medical necessity, bundling, modifiers, DRGs/APCs, sequencing, and procedures.
Collaborate with CDI, billing, providers, and revenue integrity.
Monitor denial trends and recommend improvements.
Review coding-related claim rejections before adjudication.
Correct coding errors causing claim rejections.
Validate diagnosis/procedure combinations and modifier usage.
Partner with billing to reduce preventable rejections.
Track recurring rejection trends.
Maintain HIPAA compliance.
Remain current on coding and payer updates.
Follow CMS, AHIMA, AAPC, AMA, and payer guidance.
Meet departmental productivity and QA expectations. (95% or greater)
Work with Coding Leadership, CDI, Revenue Cycle, Revenue Integrity, Billing, and Providers.
Assist with education, process improvement, and mentoring.
Communicate coding and payer updates to the team.