The Medical Coding Specialist is responsible for reviewing clinical documentation to assign accurate ICD-10, CPT, and HCPCS codes. This role ensures compliant claims submission, supports the revenue cycle by minimizing claim denials, and maintains strict adherence to federal and state healthcare regulations. Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Health System Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.
Responsibilities: Translate diagnoses, procedures, and medical services for all Banyan services including behavioral health, psychiatry, and primary care into standardized universal codes for billing
Ensure all charges are reviewed, coded, and posted within 72 hours
Collaborate with the billing team to resolve coding-related claim edits, research denials, and facilitate insurance reimbursement
Communicate with healthcare providers to clarify ambiguous documentation and improve clinical documentation integrity
Maintain strict confidentiality and compliance with HIPAA guidelines, CMS regulations, and standard medical coding conventions
Stay current on all changing coding guidelines, regulatory standards, and Medicare/payer announcements
Review and advising about HEDIS measures
Educate Physicians regarding proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
Prepares and submits to the supervisor the reports required
Ability to maintain effective working relationships with employees
Collaborate with RCM Leadership when changes are necessary
Education: An Associate degree in Health Information Technology is preferred. Work experience may substitute for a degree. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is required.
Knowledge: Advanced knowledge of medical and insurance terminology
Advanced Knowledge and demonstrated proficiency in medical insurance plans, billing and regulations, and manage care plans.
Strong ability to multi-task and work under pressure to meet deadlines.
Working knowledge of applicable Federal, State, and local laws and regulations desired
Working knowledge of CPT and ICD-10 codes as they relate to financial clearance
Strong knowledge of medical terminology, anatomy, physiology, and experience navigating Electronic Health Record (EHR) systems.
Proven experience in medical coding, with proficiency in ICD-9, ICD-10, CPT coding
Excellent attention to detail, organizational skills, and ability to interpret complex clinical documentation
Experience: Minimum 2-3 years of experience as a certified coder
Previous experience with HEDIS, Risk-Adjustment, and value-based contracts
Experience in behavioral health, psychiatry, and primary care coding
Job Type: Full-time
100% Paid Health Insurance (Employee Base Plan)
100% Employer-Paid Basic Life Insurance
Dental, Vision, Short-Term Disability (STD), Long-Term Disability (LTD), Secondary Health Insurance, and Other Voluntary Benefit Plans
403(b) Retirement Plan with Employer Matching
Student Loan Forgiveness Opportunities
Potential HRSA Student Loan Repayment for eligible licensed positions*
Opportunities for Career Growth and Professional Development
Certain licensed positions working in qualifying outpatient settings may be eligible for the HRSA National Health Service Corps Loan Repayment Program. Eligibility is subject to HRSA requirements and position responsibilities and will be confirmed during the hiring process.
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