We are a growing Arthritis and Rheumatology Center, seeking a highly experienced Lead Certified Medical Coder to support a compliance-driven rheumatology and infusion practice in Cumming, GA. This role is in-person and requires expert-level knowledge of rheumatology and biologic infusion coding, strict adherence to CMS and payer regulations, and active oversight of coding compliance through audits, monitoring, and corrective action. The Lead Coder serves as the primary coding authority and risk mitigation resource for the organization.
Key ResponsibilitiesCoding Compliance & Audit OversightEnsure accurate and compliant coding of rheumatology services, biologic therapies, and infusion encounters
Apply CPT, ICD-10-CM, HCPCS (including J-codes), modifiers, units, and wastage in strict accordance with CMS and payer guidelines
Validate documentation supports medical necessity, infusion start/stop times, dosing, and administration requirements
Conduct routine internal coding audits with documented findings and corrective actions
Identify compliance risks, undercoding/overcoding trends, and audit vulnerabilities
Prepare documentation and coding support for external audits and payer reviews
Maintain audit logs, compliance reports, and corrective action plans
Stay current on regulatory updates, NCCI edits, LCDs, NCDs, and payer infusion policies
Provide direct oversight of the coding team with accountability for compliance and accuracy
Review coder output for audit readiness, consistency, and adherence to specialty standards
Establish and enforce coding policies, workflows, and quality benchmarks
Train and mentor coding staff on rheumatology- and infusion-specific compliance requirements
Serve as escalation point for complex, high-risk, or audit-sensitive coding decisions
Partner with compliance, billing, and A/R leadership to reduce regulatory risk and denials
Qualifications
Active coding certification required (from AAPC)
3–5+ years of medical coding experience, with rheumatology and infusion coding required
Demonstrated experience in audit-focused or compliance-driven environments
Strong working knowledge of CMS regulations, payer policies, LCDs/NCDs, and infusion guidelines
Prior experience in a lead, senior, or supervisory coding role preferred
Advanced understanding of E/M guidelines, modifiers, NCCI edits, and drug billing rules
Excellent analytical, documentation, and leadership skills
Benefits: