Medical Coding Specialist

Ensemble Health Partners • Work at Home - Ohio - Other, OH

6d • $20 - $25 • Remote

About The Position

The Medical Coding Specialist reviews medical record documentation, assigns appropriate diagnosis and procedure codes, and abstracts specified data elements in compliance with federal regulations and established coding guidance. The role handles outpatient work types including ancillary, urgent care, emergency department, observation, same-day surgery, and interventional procedures. It follows official coding guidelines and applicable AHIMA, AHA, CMS, and payer requirements while using coding applications and established workflows. The specialist also maintains required quality and productivity standards.

The position works with multiple professional-fee specialties, including HemOnc/Interventional Radiology, Orthopedics, Allergy/ENT, OBGYN, Cardiology, General Surgery, Pediatric General Surgery, and Pulmonology. It is remote, with travel to and work at client, temporary, or corporate office locations as business needs require.

Requirements

• High school diploma or GED.
• AAPC or AHIMA coding certification: CPC-A, CPC, CCA, or CCS.
• PC and computer application knowledge and experience, including basic navigation and functional expertise in Microsoft Excel, Word, and PowerPoint.
• Strong organization, communication, time management, troubleshooting, and problem-solving skills.
• Ability to multitask and prioritize needs to meet short- and long-term timelines.
• Must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.
• Must reside and be authorized to work in the United States.

Nice To Haves

• One year of previous coding experience.
• Experience with EPIC and prior use of coding software tools.
• Experience in multiple professional-fee specialties, including HemOnc/Interventional Radiology, Orthopedics, Allergy/ENT, OBGYN, Cardiology, General Surgery, Pediatric General Surgery, and Pulmonology.
• Inquisitiveness and openness to innovation, including AI, to explore improved processes and patient and client experiences.

Responsibilities

• Review medical record documentation and assign appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes using 3M software tools for outpatient work types.
• Ensure assigned codes support the reason for the visit and the documented medical necessity of the care provided.
• Apply appropriate charges when applicable, including Evaluation & Management levels, injections and infusions, and requirements for observation cases, using systems such as LYNX.
• Abstract required data according to facility specifications.
• Perform medical necessity checks for Medicare and other payers as required by payment guidelines.
• Monitor and work accounts including Discharged Not Final Billed, failed claims, stop bills, and epremis as part of a team to support timely, compliant outpatient claim processing.
• Meet established productivity requirements and key performance indicators for 3M 360 CAC for CRS and Direct Code, while maintaining required accuracy and quality standards.
• Stay current with CMS requirements, including National Coverage Determinations, Local Coverage Determinations, and modifier guidelines, to support clean claims.
• Maintain competency and accuracy using coding tools and references, and report coding software inaccuracies to HIM management or a supervisor.
• Report potential unethical or fraudulent activity in accordance with compliance policy.
• Attend required system, hospital, and departmental meetings and educational sessions, and complete required annual learning programs.

Benefits

• Bonus incentives and quarterly and annual incentive programs.
• Paid certifications and professional development.
• Tuition reimbursement.
• Comprehensive benefits, including healthcare, time off, retirement, and well-being programs.
• Career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED