Certified Coder

Certified Coder

Position Summary

The Certified Coder is responsible for performing accurate and compliant coding of inpatient (IP) and outpatient (OP) medical records to support timely billing and maximize revenue integrity. This role ensures correct diagnostic and procedural coding in accordance with ICD-10-CM, CPT, HCPCS, CMS guidelines, and payer-specific requirements. The certified coder works closely with billing teams, clinical staff, and auditors to support clean claim submissions, reduce denials, and promote optimal reimbursement.

Key Responsibilities

Review, analyze, and accurately assign ICD-10-CM, CPT, and HCPCS codes for inpatient and outpatient encounters, including surgeries, ancillary services, ER, observation, and clinic visits.

Validate documentation to ensure it supports assigned codes and meets regulatory, compliance, and payer-specific rules.

Work collaboratively with providers to obtain missing documentation or clarification using compliant query processes.

Ensure coding meets all CMS, OIG, and organizational standards for accuracy and integrity.

Assist billing and denial teams with coding-related claim edits, rejections, and appeals.

Monitor coding trends to proactively identify issues, documentation gaps, or opportunities for education.

Participate in internal audits and quality reviews to support continuous improvement.

Maintain productivity and accuracy benchmarks established by the RCM department.

Stay current with coding updates, regulatory changes, and payer guidelines.

Protect patient confidentiality in accordance with HIPAA regulations.

Perform additional related duties as assigned or required by leadership to support the needs of the department and company.

Required Qualifications

High school diploma or equivalent.

Active certification through AAPC (CPC, CRC, COC) or AHIMA (CCS, CCS-P) required.

Minimum of 2–3 years of coding experience with both inpatient and outpatient coding.

Strong understanding of ICD-10-CM, CPT/HCPCS, MS-DRG, APCs, NCCI edits, and payer rules.

Experience with EHRs and coding platforms (Epic, Cerner, Meditech, etc.).

Ability to interpret medical documentation and provider notes accurately.

Excellent analytical, problem-solving, and communication skills.

Ability to meet deadlines in a fast-paced RCM environment.

Preferred Qualifications

Experience working in a Revenue Cycle Management (RCM) company or large physician/hospital setting.

Familiarity with denial management and appeals.

Knowledge of Medicare, Medicaid, and commercial payer policies.

Strong computer literacy, including advanced proficiency with coding software and Excel.

Competencies

Critical Thinking & Root Cause Analysis

Attention to Detail and Accuracy

Time Management & Prioritization

Problem-Solving and Decision-Making

Communication & Professionalism

Regulatory and Compliance Awareness

Physical Requirements

Prolonged periods of sitting and computer use.

Ability to work independently with minimal supervision.

Remote