Medical Coder

Innovaccer Analytics

About The Position

The Medical Coder independently reviews, analyzes, and resolves assigned front-end claim holds, scrubs, and denied claims to support accurate and timely payment. The role identifies and corrects coding issues before claim submission, submits corrected claims or appeals denied claims, and applies established coding guidelines, payer requirements, and organizational policies. The position works with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement. It requires attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. The coder averages 10 front-end holds or denials per hour and maintains a minimum 92% coding accuracy. The role assigns ICD-10-CM and CPT codes with appropriate modifiers in the professional fee environment, reviews medical records and documentation, and ensures diagnosis codes meet local and national medical necessity guidelines. The coder uses internal resources, payer guidelines, and reference materials to ensure accurate and compliant coding; follows HIPAA privacy and confidentiality requirements; maintains current knowledge of relevant laws, regulations, payer policies, and industry guidance; and completes required continuing education units. The role participates in department, one-on-one, and mentorship meetings, escalates client trends and coding questions to the assigned Coding Manager, and performs other assigned duties.

Requirements

Hold a current AAPC or AHIMA coding certification for at least 3 years.
At least 3 years of professional coding experience.
Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
Prior experience reviewing front-end coding errors before insurance submission.
Prior experience reviewing and correcting coding from insurance denials.
Prior experience submitting corrected claims and appeals.
Prior experience with insurance guidelines and EOBs.
Familiarity with proper English grammar, usage, and professional documentation standards.
Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues.
Ability to read, interpret, and apply policies, procedures, laws, and regulations.
Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures.
Demonstrated ability to exercise independent judgment in coding and claim resolution.
Excellent written and verbal communication skills, including preparing reports, clarifying documentation needs, and maintaining collaborative relationships with physicians and staff.
Strong commitment to confidentiality and safeguarding protected health information.
Prior experience in a medical billing environment with strict adherence to HIPAA compliance requirements.
Demonstrated proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams.

Responsibilities

Review, analyze, and resolve assigned front-end claim holds, scrubs, and denials.
Review coding and resubmit corrected claims to insurance.
Prepare appeal letters or forms and include medical documentation.
Average 10 front-end holds or denials per hour and maintain at least 92% coding accuracy.
Assign ICD-10-CM and CPT codes with appropriate modifiers for professional fee services.
Review medical records and applicable documentation to determine appropriate codes for documented services and diagnoses.
Ensure diagnosis codes meet local and national medical necessity guidelines.
Use internal coding resources, payer guidelines, and reference materials to ensure accurate and compliant coding.
Follow HIPAA regulations and protect privacy and confidentiality.
Maintain current knowledge of laws, regulations, payer policies, and industry guidance affecting compliant coding.
Participate in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead.
Escalate identified client trends and coding-related questions to the assigned Coding Manager.
Complete all continuing education unit requirements.
Perform other duties or tasks as assigned.