Health Business Solutions LLC

Certified Medical Coder

Status: Non-Exempt   Department: Coding Reports To: Coding Director Work Location: Remote

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 while maintaining the highest standards of coding compliance and data integrity.

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.
• Collaborate with providers to obtain missing documentation or clarification using compliant query processes.
• Ensure coding meets all CMS, OIG, HIPAA, and organizational standards for accuracy, integrity, and compliance.
• Assist billing and denial teams with coding-related claim edits, rejections, and appeals.
• Monitor coding trends to identify root causes of denials, documentation gaps, or training opportunities.
• Participate in internal audits, external audits, and quality reviews to support continuous improvement and compliance readiness.
• Meet or exceed established productivity and accuracy benchmarks defined by the RCM department.
• Maintain knowledge of annual coding updates, payer policy changes, and regulatory guidance.
• Protect patient confidentiality and follow all HIPAA and information-security requirements, including secure remote work practices.
• Perform additional related duties as assigned to support departmental and organizational needs.

Required Qualifications

• High school diploma or equivalent required.
• Active certification through AAPC (CPC, CRC, COC) or AHIMA (CCS, CCS-P) required and must be maintained in good standing.
• Minimum 2–3 years of professional coding experience in inpatient and outpatient settings.
• Strong knowledge of ICD-10-CM, CPT/HCPCS, MS-DRG assignment, APC methodology, NCCI edits, LCD/NCD rules, and payer-specific guidelines.
• Demonstrated ability to interpret clinical documentation and assign accurate codes.
• Experience using EHR and coding platforms (Epic, Cerner, Meditech, etc.).
• Strong analytical, organizational, and communication skills.
• Ability to work independently and meet deadlines in a fast-paced RCM environment.

 Preferred Qualifications

• Experience working in a Revenue Cycle Management company or large health system.
• Familiarity with denial management, coding edits, and appeals.
• Knowledge of Medicare, Medicaid, and commercial payer policies.
• Advanced computer skills, including Excel and coding analytics tools.
• Experience participating in coding audits or education initiatives.

Core Competencies

• Critical Thinking & Root Cause Analysis
• Attention to Detail and Coding Accuracy
• Time Management & Productivity Focus
• Problem-Solving & Decision-Making
• Professional Communication
• Regulatory & Compliance Awareness

 Physical & Work Requirements

• Prolonged periods of sitting and computer use.
• Must maintain a secure remote work environment that protects PHI and company systems.
• Ability to work independently with minimal supervision while maintaining productivity and quality standards.

Job Type

Full-Time

Benefits

• 401(k) with employer match
• Health, Dental, and Vision Insurance
• Life Insurance
• Paid Time Off

 Equal Opportunity Statement

HBiz is an Equal Opportunity Employer and does not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other protected classification under applicable federal, state, or local law.

 Job Description Disclaimer

This job description is intended to describe the general nature and level of work performed by employees in this role. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications. HBiz reserves the right to modify duties or assign additional responsibilities as business needs evolve.