Job description
Job Description:
• Review clinical documentation and diagnostic results to ensure accurate CPT and ICD-10 coding.
• Validate medical necessity and ensure coding aligns with CMS and payer-specific guidelines.
• Process charge captures and review billing system edits to prevent claim denials.
• Collaborate with providers and billing teams to clarify documentation or coding inconsistencies.
• Identify coding trends, resolve payer denials, and provide recommendations for improvement.
• Assist with provider education on documentation and coding compliance.
• Maintain production standards and report daily coding productivity and quality metrics.
Requirements:
• High School Diploma or GED required.
• Completion of a formal coding program (AHIMA, CCS, or AAPC preferred).
• Minimum of 3 years’ applied coding experience OR 5 years of OB/GYN coding experience in a physician billing or revenue cycle setting; Emphasize on OB/GYN coding!
• Proficiency in ICD-10, CPT, medical terminology, anatomy, and health record content.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) preferred.
• Non-certified coders with strong experience may be required to obtain certification within an agreed timeframe.
• In-depth knowledge of Medicare, Medicaid, and managed care plans (HMO, PPO, POS, Indemnity).
• Understanding of HIPAA, Medicare Fraud and Abuse regulations, and EHR/Billing systems.
• Strong analytical and organizational skills with attention to detail.
• Proficiency in Microsoft Office (Word, Excel, Outlook) and healthcare billing platforms.
• Excellent verbal and written communication skills.
• Customer-focused approach and ability to work effectively with clinical staff and patients.
Benefits:
• Competitive compensation
• Medical, dental & vision plans, with an HSA/FSA option
• 401(k) with employer match
• Paid time off
• Paid parental leave