Upward Health-posted 7 months ago
$60,000 - $65,000/Yr
Bvl, FL

The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT/HCPCS codes, ensuring compliance with coding guidelines, third-party reimbursement policies, and accreditation standards. This role involves performing coding duties for complex cases, including auditing, reporting, and collaborating with providers to address coding corrections and clarifications. The individual will distribute monthly audit reports, address any questions or concerns from providers, and offer training to staff on coding processes and requirements. Additionally, the role includes resolving discrepancies in coding, reviewing and correcting rejected claims from third-party carriers, and performing other coding duties as assigned by management to ensure accurate and timely submissions.

  • Analyze provider documentation to select ICD-10 and CPT/HCPCS codes.
  • Ensure compliance with coding guidelines and third-party reimbursement policies.
  • Perform coding duties for complex cases, including auditing and reporting.
  • Collaborate with providers to address coding corrections and clarifications.
  • Distribute monthly audit reports and address questions from providers.
  • Offer training to staff on coding processes and requirements.
  • Resolve discrepancies in coding and review rejected claims.
  • Perform other coding duties as assigned by management.
  • Minimum 2 years of risk coding experience, preferably in primary care or behavioral health.
  • Certification in Professional Coding (CPC) required; Certification in Risk Adjustment Coding (CRC) preferred.
  • High school diploma or GED required; Associate's degree preferred.
  • Proficiency in Microsoft Office, especially Excel.
  • Strong understanding of ICD-10, CPT, and HCPCS coding systems.
  • Ability to work independently in a remote environment.
  • Strong interpersonal skills to build relationships with colleagues and external auditors.
  • Excellent written and verbal communication skills.
  • Ability to multitask and prioritize effectively in a fast-paced environment.
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