4672-Medical Coder

Innovaccer Analytics

16d

About The Position

The Coding Specialist independently reviews, analyzes, and resolves assigned front-end claim holds, coding issues, and denied claims to support accurate and timely claim payment. The role identifies and corrects coding issues before claim submission, resubmits corrected claims, and appeals denied claims in accordance with coding guidelines, payer requirements, and organizational policies. It works with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement. The position requires attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.

The Coding Specialist assigns ICD-10-CM and CPT codes, including appropriate modifiers, for professional-fee services; reviews medical records and documentation; and ensures diagnosis codes meet applicable medical-necessity guidelines. The position uses internal resources and payer guidance to code accurately and compliantly, maintains HIPAA privacy and confidentiality, and keeps current with relevant laws, regulations, payer policies, and industry guidance. It also participates in department, one-on-one, and mentorship meetings; escalates client trends and coding questions to the appropriate manager; and completes required continuing education. The expected workload averages 10 front-end holds or denials per hour, with a minimum coding accuracy of 92%.

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.
• Experience reviewing front-end coding errors before claims are submitted to insurance.
• Experience reviewing and correcting coding issues from insurance denials.
• Experience submitting corrected claims and appeals.
• 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.
• 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.
• Commitment to confidentiality and safeguarding protected health information.
• Experience working in a medical billing environment with strict adherence to HIPAA requirements.
• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams.

Responsibilities

• Review, analyze, and resolve assigned front-end claim holds, coding issues, and denied claims.
• Review coding and resubmit corrected claims to insurance.
• Prepare appeal letters or forms with supporting medical documentation.
• Assign ICD-10-CM and CPT codes, including 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 other reference materials to ensure accurate and compliant coding.
• Follow HIPAA regulations and maintain privacy and confidentiality.
• Maintain current knowledge of laws, regulations, payer policies, and industry guidance affecting compliant coding.
• Participate in department, one-on-one, and mentorship meetings with the assigned Coding Team Lead.
• Escalate identified client trends to the assigned Coding Manager and coding questions to the assigned Coding Manager for guidance.
• Complete all continuing education unit requirements.
• Perform other duties or tasks as assigned.

Benefits

• 20 days of fixed paid time off per year, in addition to company holidays.
• Parental leave.
• Monetary incentives and company-wide recognition.
• Medical, dental, and vision insurance.
• Company-paid short- and long-term disability insurance and basic life insurance.
• Optional discounted legal aid and pet insurance.

What This Job Offers

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