Medical Coding Specialist
Major Responsibilities:
- Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines, or;
- Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
- Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
- Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
- Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
- May provide informal guidance to new coding staff on professional coding nuances
Licensure, Registration, and/or Certification Required:
- An active coding certification issued by the American Academy of Coders (AAPC) OR American Health Information Management Association (AHIMA);
- Dual certifications, preferred
Education Required:
- High School Diploma or Equivalent required
- Completion of an accredited medical coding or HIM program (or equivalent experience)
Experience Required:
- Minimum of 3-5 years of direct professional fee coding experience in a multi-specialty environment is required
- Experience with professional procedural coding (e.g., surgical, interventional procedures) is preferred
- Experience with Epic or similar electronic health record systems is required
Knowledge, Skills & Abilities Required:
- Proficient knowledge of medical terminology, anatomy, and pathophysiology
- Advanced proficiency in CPT/HCPCS and ICD-10-CM/PCS coding systems
- Basic understanding of facility payment methodologies (MS-DRGs) as they apply to simple encounters
- Strong analytical skills, attention to detail, and ability to context-switch between different coding guidelines
- Ability to work independently, manage a varied workload, and meet deadlines in a fast-paced environment
Physical Requirements and Working Conditions:
- Exposed to normal office environment in a remote work setting
- Job may require occasional travel for training or meetings, therefore, may be exposed to road and weather hazards
- May need to be able to lift up to 40 lbs. occasionally (e.g., equipment)
- Sits the majority of the workday, but also may lift, reach, and bend throughout the day
- Operates all equipment necessary to perform the job
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.