Coding Specialist

Infinx•, (Multiple States)

1d•$19 - $22•Remote

About The Position

The Coding Specialist assigns accurate diagnosis and procedure codes for inpatient, outpatient, and ambulatory encounters, including clinic visits, ambulatory surgery, observation, emergency department, and ancillary services. The role requires expert command of ICD-10-CM, CPT, HCPCS, and modifier usage, along with strict adherence to official coding guidelines and payer policy. This position operates in a high-volume, metrics-oriented outsourced environment with client-specific accuracy and productivity targets. The Coding Specialist resolves coding-related claim rejections and denials, supports documentation improvement, and maintains current working knowledge of payer policy and regulatory changes. Assignments may shift across ambulatory specialty areas based on client needs and individual strengths within the scope of the role. The position is remote.

Requirements

High school diploma or GED.
At least 1 year of medical coding experience.
Expert command of ICD-10-CM, CPT, HCPCS, and modifier rules.
Familiarity with NCCI edits, MUE edits, global edits, and LCD/NCD policies.
Proficiency with encoder tools such as 3M, TruCode, Optum EncoderPro, or comparable tools, and with EHR and PMS systems.
Strong understanding of clinical documentation and ability to draft compliant, non-leading physician queries.
Excellent attention to detail and ability to maintain accuracy under productivity pressure.
Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers.
Ability to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective manner.
Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations.

Nice To Haves

Multi-specialty coding experience, such as surgery, cardiology, GI, orthopedics, oncology, or primary care.
Experience with split/shared visits, incident-to, and time-based E&M coding under current CMS guidelines.
Prior experience supporting coding audits, authoring formal appeals, or responding to external payer audits.
Current coding certification through AAPC (CPC, COC) or AHIMA (CCS, CCS-P, RHIA, RHIT).

Responsibilities

Assign accurate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes for ambulatory encounters in accordance with official coding guidelines, AMA CPT guidance, and payer-specific policy.
Apply correct modifiers, including 25, 26, 27, 50, 59, XE/XP/XS/XU, LT/RT, and global period modifiers, to support accurate reimbursement and pass NCCI and global edits.
Code encounters across ambulatory settings, including clinic E&M, ambulatory surgery, observation, emergency department, infusion/injection, diagnostic imaging, and ancillary services.
Review clinical documentation to confirm medical necessity and support code selection; submit compliant, non-leading physician queries when documentation is unclear, incomplete, or contradictory.
Apply correct sequencing of primary and secondary diagnoses and link diagnoses appropriately to procedures.
Identify and report charge capture errors, missing charges, and documentation deficiencies to the appropriate upstream owner.
Maintain coding accuracy at or above the client-defined threshold, typically 95%, and meet daily productivity targets as defined by the client.
Document coding rationale and query activity clearly in the encoder, EHR, or coding workflow tool.
Resolve coding-related claim rejections and denials by reviewing payer responses, applying corrected codes or modifiers, providing supporting documentation, and following claims through to resolution.
Maintain current working knowledge of best coding practices, payer policy, and regulatory changes by accessing NCD, LCD, and coding policy resources and participating in continuing education.
Stay current with annual ICD-10-CM, CPT, and HCPCS code set updates, MPFS final rules, and payer policy changes.
Maintain full compliance with HIPAA, CMS regulations, and fraud/abuse regulations, including the False Claims Act.