Medical Coding Specialist

Integra Partners•Troy, MI

2d•$65,000 - $65,001•Remote

About The Position

The Medical Coding Specialist provides coding expertise to support Utilization Management operations, health plan implementations, prior authorization program development, and clinical policy initiatives. This position is responsible for researching, analyzing, and interpreting HCPCS, CPT, and ICD-10 coding guidance to support accurate prior authorization requirements, coding resources, and client deliverables across Medicare, Medicaid, Commercial, and Marketplace lines of business. The Medical Coding Specialist partners with clinical, operational, compliance, business development, and client teams to ensure coding recommendations are accurate, compliant, and operationally sound. Success in this role requires strong attention to detail, critical thinking, organization, and the ability to produce high quality work while managing multiple priorities.

Requirements

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or equivalent coding certification required/accepted.
High school diploma or equivalent required.
Minimum of 3 years of medical coding experience.
Experience with HCPCS, CPT, and ICD-10 coding required.
Experience reviewing CMS guidance, payer policies

Nice To Haves

Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferred.
Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer operations preferred.
Knowledge of Medicare, Medicaid, and Commercial coding methodologies preferred.

Responsibilities

Research, analyze, and interpret HCPCS Level II, CPT, ICD-10-CM, and related coding guidance.
Review coding resources, CMS guidance, payer policies, and regulatory requirements to support coding decisions.
Assist with determining prior authorization requirements and appropriate code categorization.
Apply coding knowledge across Medicare, Medicaid, Commercial, and Marketplace products.
Develop, validate, and maintain Prior Authorization code lists and coding reference materials.
Support implementation of new health plans, benefit designs, and coding configurations.
Review client specific coding requirements and ensure recommendations align with contractual and regulatory requirements.
Identify opportunities to improve coding consistency and operational efficiency.
Perform thorough self review of work prior to submission to ensure accuracy, completeness, and consistency.
Validate coding deliverables for duplicate records, formatting, categorization, and completeness.
Maintain accurate documentation supporting coding decisions and recommendations.
Meet established quality standards and project deadlines.
Research unfamiliar coding scenarios using available coding resources and regulatory guidance.
Identify questions or areas requiring clarification early in the work process.
Present questions with supporting research and a recommended approach when seeking guidance.
Participate in discussion and resolution of coding issues with internal stakeholders.
Serve as a coding resource for Medical Management and other internal departments.
Partner with clinical, operational, provider relations, credentialing, compliance, and business development teams on coding related initiatives.
Support client implementations, operational projects, and coding validation activities.
Participate in internal and external meetings as needed.
Maintain current knowledge of coding regulations, CMS guidance, and industry best practices.
Assist with development of coding guidance documents, training materials, and internal reference tools.
Participate in audits, quality improvement initiatives, and accreditation activities.
Perform other duties as assigned.