Medical Coder

SUMMARY

The Medical Coder is responsible for reviewing clinical documentation and accurately assigning diagnostic, procedural, and billing codes for medical, dental, behavioral health, and ancillary healthcare services provided by CTCLUSI Health Services. This position supports compliant billing practices, reimbursement optimization, and accurate health record documentation in accordance with tribal, federal, applicable state, and payer requirements. The Medical Coder wit collaboratively with providers, [DS1.1]clinical staff, billing personnel, and leadership to ensure timely and accurate coding, claim submission readiness, and compliance with all applicable regulations and standards.

Note: This position is fully remote and requires the employee to maintain a secure, confidential workspace that complies with HIPAA and CTCLUSI confidentiality requirements.

PRINCIPAL ACTIVITIES & RESPONSIBILITIES:

• Reviews medical records and provider documentation to assign accurate ICD-10, HCPCS, CDT, and modifier codes as appropriate.
• Ensures coding accuracy and compliance with applicable payer guidelines including Medicare, Medicaid, commercial insurance, HIS, and Tribal billing requirements.
• Performs coding review for medial, dental[DS2.1], behavioral health, Pharmacy, PRC, and ancillary services as assigned.
• Identifies documentation deficiencies and communicates with providers regarding clarification or correction needs.
• Supports timely charge entry, claim processing, and reimbursement activities.
• Assists with denial management and coding-related claim corrections.
• Monitors coding changes, payer updates, and regulatory requirements to maintain coding compliance.
• Participates in internal audits, quality assurance reviews, and compliance monitoring activities.
• Maintains confidentiality of patient, employee, and Tribal information in accordance with HIPAA and Tribal policies.
• Collaborate with Revenue Cycle, clinical staff, and leadership to improve coding workflows and revenue cycle efficiency.
• Assists with training and education related to coding requirements and documentation standards.
• Maintains productivity and accuracy standards established by management.
• Collaborates efficiently and effectively while consistently demonstrating professionalism and maintaining positive, respectful relationships with internal teams, external partners, and Tribal members.
• Other duties as directed by management.

LEVEL OF AUTHORITY & RESTRICTIONS

• This position requires working independently without overseeing others, with no authority in decision-making.
• This position requires working independently without overseeing others, with minimal authority in decision-making.
• This position has no formal supervisory responsibilities or authority but may support training efforts and provide guidance to staff within established procedures.

PHYSICAL & MENTAL DEMANDS

• Must be able to sit for extended periods while performing computer-based work.
• Must be able to use hands and fingers to operate computer equipment and office tools.
• Vision abilities required include close vision and ability to adjust focus.
• Must possess attention to detail and the ability to maintain concentration for extended periods.
• May occasionally lift or carry office materials up to 20 pounds.

WORKING CONDITIONS & ENVIRONMENT

• This is a fully remote position requiring regular and reliable internet access and the ability to work independently in a secure home office environment.
• Employee must maintain a private workspace sufficient to protect confidential information and comply with HIPAA requirements.
• Extensive computer and telephone use required throughout the workday.
• Moderate noise level with frequent interruptions and competing priorities.
• May require occasional travel for meetings, trainings, audits, conferences, or Tribal events.
• Must be available during established business hours and maintain consistent communication with supervisors and employees.
• May require occasional evening or weekend work depending on operational needs.
• Will require working occasional nights and/or weekends.
• Moderate noise level with frequent interruptions and distractions.

MINIMUM JOB REQUIREMENTS

• Must be 18 years of age or older.
• High School Diploma or equivalent.
• Minimum of two (2) years of medical coding experience in a healthcare setting.
• Current coding certification required or preferred, including CPC, CCS, CCA, RHIT, or equivalent credential.
• Knowledge of ICD-10, CPT, HCPCS, CDT, and medical terminology.
• Knowledge of Medicare, Medicaid, commercial insurance, FQHC, HIS, and Tribal billing practices preferred.
• Experience with EHR and Practice Management systems preferred.
• Strong attention to detail and organizational skills.
• Ability to maintain confidentiality and exercise sound judgment.
• Must demonstrate the ability to work successfully in a remote environment with minimal direct supervision.
• Experience and proficiency in the use of Microsoft products (Excel, Outlook, PowerPoint, Word, etc).
• Ability to communicate clearly and effectively in English, verbally, in writing or by other acceptable means.
• This position is considered a non-covered role per the CTCLUSI Background Investigations Policy. A state criminal background check and fingerprint-based background check will be required as a condition of employment.
• This position is subject to pre-employment and other authorized drug and alcohol testing in accordance with company policy.
• Must have employment eligibility in the U.S.
• Indian preference will be observed in the hiring process.