4366- Coding Specialist

About this role

About the Role 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. A Day in the Life 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.

Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality. 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. Maintains and completes all CEU requirements. Performs other duties or tasks as assigned What You Need 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.