Coding & RCM Specialist
About The Position
We are seeking a detail-oriented Coding & RCM Specialist to support accurate coding and clean claims submission in a complex Medicaid and managed-care environment. This is a hands-on, production-focused role centered on CPT and ICD-10 coding accuracy and documentation review. You will partner with Revenue Cycle, Clinical Operations, and Finance to ensure services are coded correctly, documentation supports billed services, and common denial risks are caught early. This role is ideal for someone with 3–5 years of coding experience who enjoys detail-oriented work, pattern recognition, and improving claim quality through consistent execution.
Requirements
- Certifications: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Technical Skills: Advanced proficiency with ICD-10, CPT, and HCPCS coding systems. Experience working with EHR systems, clinical notes, and medical billing software required.
- Experience: Minimum of 3-5 years of professional experience in medical coding and billing required.
- Detail-Oriented: Exceptional accuracy and attention to detail in coding/billing and documentation.
- Regulatory Knowledge: Strong understanding of HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
- Problem-Solving Expertise: Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy. Must be comfortable with EOBs, patterns, and payer behavior.
Nice To Haves
- Experience working with RCM and billing vendors is a strong plus.
- Strong preference for candidates with experience in behavioral health coding and expertise in Medicaid and managed-care systems.
- Experience with denial resolutions, coding audits, and QA review preferred.
Responsibilities
- Own CPT/ICD-10 coding and strategy across psychiatry and medication management, with a focus on high-acuity and complex patient populations.
- Review clinical documentation (eg SOAP notes) and supporting information to ensure clean claim submission.
- Improve first-pass claim acceptance by proactively ensuring correct coding, flagging inconsistencies, and documenting gaps for correction.
- Perform pre-bill and post-pay audits on a rolling basis.
- Review EOBs and denial trends to identify recurring coding issues.
- Document audit findings using structured templates and tracking tools.
- Flag systemic risks to improve the process and escalate high-risk patterns or unusual payer behavior when necessary.
- Work closely with billing team members, senior management, and vendors to resolve claim issues.
- Support coding corrections and resubmissions, provide clarification, and maintain internal reference guides for other team members when necessary.
- Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines.
- Monitor changes in payer policies and stay up to date on behavioral health and psychiatry guidelines.
- Partner with the credentialing and billing teams on implementing new payer contracts and RCM workflows.
Benefits
- Full Health Benefits: Medical, dental, and vision
- Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave.
- Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
