Medical Coding Specialist - I

About the company

The company activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health, Atlantic Health, and Banner Health trust the company to integrate a system of intelligence into their existing infrastructure— extending the human touch in healthcare.

About the Role

The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment.

A Day in the Life

• Averages 10 front-end holds per hour

• Maintains a minimum of 90% coding accuracy.

• Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment.

• Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses.

• Ensures all diagnosis codes meet local and national medical necessity guidelines.

• Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services.

• Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.

• Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices.

• Independently reviews and resolves all assigned front-end claim holds.

• Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead.

• Escalates identified client trends to the assigned Coding Team Lead.

• Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification.

• Maintains and completes all CEU requirements.

• Performs other duties or tasks as assigned.

Requirements

What You Need

• Must hold a current AAPC or AHIMA Certification for a minimum of 3 years.

• Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.

• 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 the ability to clarify documentation needs and maintain collaborative working relationships with physicians and staff.

• Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements.

• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams).

• Minimum of 3+ years of professional coding experience.

Benefits

• Competitive pay of $24-$28 per hour

• Private Health Insurance

• Pension Plan

• Paid Time Off

• Work From Home

• Training & Development

• Performance Bonus

• Health Care Plan (Medical, Dental & Vision)

• Retirement Plan (401k, IRA)

• Life Insurance (Basic, Voluntary & AD&D)

• Family Leave (Maternity, Paternity)

• Short Term & Long Term Disability

• Wellness Resources