Medical Coder II/III

CodaMetrix • Boston, MA

5d • Onsite

About The Position

CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix’s autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care.
Overview
Reporting to the Manager, Medical Coding & Audit, as a Medical Coder II or III, this role will be a key member of the team responsible for ensuring that CodaMetrix meets—and exceeds—our customers’ coding quality expectations.
The Medical Coder II or III will be responsible for leveraging their strong background in coding, billing, and auditing across service lines to review, analyze, and enhance coding processes, both internally and externally. They will play a pivotal role in improving the quality and efficiency of coding operations by collaborating closely with cross-functional teams, including Machine Learning, Product, and Customer Implementations. They will also review and validate model-generated codes, annotate and label data to support model training, identify patterns in coding errors, and provide clear explanations and insights to both internal teams and external clients.
This role requires a proven ability to communicate highly complex coding issues and solutions to a wide range of stakeholders, alongside an unwavering commitment to continuous learning, quality, and innovation in medical coding practices.

Requirements

• Current AHIMA or AAPC coding credential held for 3+ (level II) or 5+ years (level III).
• 3-5 (level II) or 5+ years (level III) of coding and auditing experience with progressive growth in responsibilities.
• Strong understanding of CPT, ICD-10-CM, HCPCS, modifiers, and 2023 E/M guidelines
• Experience in one of the following specialties: Professional hospital coding; specifically in Surgery, Endoscopy, Hospitalist, Cardiology, Emergency coding
• Demonstrated ability to interpret clinical documentation and identify gaps
• Excellent communication and customer service skills, capable of effectively engaging executives, directors, data scientists, and other stakeholders with varying levels of coding knowledge.
• Ability to translate complex coding guidelines to non-clinical team members.
• Strong organizational and detail-oriented approach with a demonstrated commitment to excellence and precision.
• Critical thinking, intellectual curiosity, and creativity in problem-solving.
• Ability to thrive under time constraints in a fast-paced environment.
• Team-oriented approach with a positive and patient demeanor, fostering collaboration and continuous improvement.

Nice To Haves

• Experience in Radiology or Pathology
• Prior experience with ML/AI workflows
• Experience working with JIRA or other project management/ task management tools
• Familiarity with autonomous coding platforms
• Experience serving large health systems from a services or technology perspective

Responsibilities

• Serve as the internal and external Subject Matter Expert (SME) on medical coding and billing across assigned service lines.
• Review and validate model-generated CPT, ICD-10-CM, HCPCS, and E&M codes
• Perform high-quality coding and auditing on inpatient, outpatient, ED, or pro-fee encounters (depending on specialty)
• Ensure documentation fully supports coding decisions in alignment with AMA, CMS, and payer guidelines
• Identify missed codes, incorrect E/M leveling, modifier errors, and insufficient documentation
• Analyze and document customers’ coding practices and workflows to facilitate optimal use of the CodaMetrix product.
• Identify and share Codametrix’s best practices for coding automation and workflow improvements with the customer.
• Present audit results to customer stakeholders and facilitate sign-off for go-live milestones.
• Assist manager with Coding Quality Assessment (CQA) projects, including work assignments, training, and quality assurance for offshore coding staff.
• Leverage CodaMetrix coding standards to drive world-class coding quality and consistency.
• Work with product and engineering to provide precise, consistent feedback on model training and data annotation
• Continuously improve evaluation and training materials on coding and billing to colleagues and customers.
• Share knowledge throughout CodaMetrix to build internal competencies and champion continuous improvement initiatives.
• Provide expert guidance on coding and billing questions to support Machine Learning and Product teams.
• Proactively stay up to date with changes in medical coding and billing by maintaining relevant certifications and participating in ongoing education.
• Uphold all legal and ethical requirements, ensuring accuracy, confidentiality, and compliance in all coding and audit activities.
• Help explain model decisions, error analyses, and coding rationales to clients
• Support customer success and implementation teams in understanding coding outputs
• Prepare clear written summaries of coding patterns, documentation issues, or model behavior
• Represent coding accuracy and detail in client conversations, as needed
• Collaborate with cross-functional teams—such as Data Science, Product, and Customer Success—to address client needs and optimize results.

Benefits

• Health Insurance: We cover 80% of the cost of medical and dental insurance and offer vision insurance
• Retirement: We offer a 401(k) plan that eligible employees can contribute to one month after their first day
• Flexibility: We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate
• Learning: All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders
• Development: We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like
• Recognition: We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers
• Office Location: A modern open plan workspace located in the bustling Back Bay neighborhood of Boston
• Additional Employer Paid Benefits: We offer employer-paid life insurance and short-term and long-term disability insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed