Medical Coding Specialist

Innovaccer Analytics

About The Position

The Medical Coding Specialist independently reviews, analyzes, and resolves assigned front-end claim holds 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 by applying coding guidelines, payer requirements, and organizational policies. The specialist works with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. The position calls for attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. The specialist assigns ICD-10-CM and CPT codes, including appropriate modifiers, for professional-fee services; reviews medical records and supporting documentation; and ensures diagnosis codes meet local and national medical necessity guidelines. The role uses internal coding resources, payer guidance, and reference materials to maintain accurate and compliant coding, follows HIPAA privacy and confidentiality requirements, and keeps current with relevant laws, regulations, payer policies, and industry guidance. It also involves participating in department and mentorship meetings, escalating client trends and coding questions to management, and maintaining continuing education requirements.

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 errors 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 working relationships with physicians and staff.
Commitment to maintaining confidentiality and safeguarding protected health information.
Experience in a medical billing environment with strict adherence to HIPAA compliance requirements.
Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and Teams.

Responsibilities

Average 10 front-end holds or denials per hour.
Review coding and resubmit corrected claims to insurance.
Prepare appeal letters or forms with medical documentation.
Maintain a minimum coding accuracy of 92%.
Assign ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional-fee environment.
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.
Independently review and resolve assigned front-end claim holds.
Participate in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead.
Escalate identified client trends to the assigned Coding Manager.
Escalate coding-related questions to the assigned Coding Manager for guidance and clarification.
Maintain and complete continuing education unit requirements.
Perform other duties or tasks as assigned.