4530-Coding Specialist

The Coding Specialist is responsible for independently reviewing, analyzing, and resolving all assigned front-end scrubs and denied claims to ensure accurate and timely claim payment. This position focuses on identifying and correcting coding-related issues prior to claim submission, resubmitting corrected claims or appealing denied claims, applying established coding guidelines, payer requirements, and organizational policies. The Coding Specialist 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.

Averages 10 front-end holds/denials per hour
Reviews coding and resubmits corrected claims to insurance
Creates appeal letters/forms with medical documentation
Maintains a minimum of 92% 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.
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 Manager.
Escalates all coding-related questions to the assigned Coding manager for guidance and clarification.
Must hold a current AAPC or AHIMA Coding Certification for a minimum of 3 years.
Minimum of 3+ years of professional coding experience.
Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
Prior experience in reviewing front end coding errors before submitting to insurance
Prior experience in reviewing and correcting coding from insurance denials.
Prior experience in submitting corrected claims and appeals.
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.
Strong commitment to maintaining confidentiality and safeguarding protected health information.
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).

Generous Paid Time Off:

Recharge and relax with 20 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance.
Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
Comprehensive Insurance Coverage:

Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. For any additional information, please visit the below websites:
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