Summary
We are looking for experienced Certified Medical Coders, specializing in payer-side healthcare operations. If you have a robust background in medical coding, claims, benefits, and healthcare reimbursement, and thrive in a fast-paced environment, we want to hear from you. This role offers the opportunity to work with a dedicated team to ensure accuracy and compliance in coding practices, contributing to the efficiency of healthcare claims and benefits administration.
Responsibilities
- Perform and review medical coding activities, including CPT, HCPCS, ICD-10-CM, and related methodologies.
- Review medical claims and supporting documentation for coding accuracy and compliance.
- Apply payer-specific coding, reimbursement, and claims-processing guidelines.
- Identify and resolve coding discrepancies, inconsistencies, and potential billing issues.
- Interpret medical records, provider documentation, and benefit plans.
- Collaborate with claims, clinical, benefits, and operations teams to resolve coding-related issues.
- Support claims auditing, quality assurance, and process improvement initiatives.
- Stay updated with changes to coding guidelines, payer policies, and healthcare regulations.
- Document findings and communicate coding decisions clearly to internal stakeholders.
- Contribute to the development and refinement of coding and claims-related processes.
Qualifications
- Active certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent.
- Professional experience in medical coding within a payer, health plan, or healthcare reimbursement environment.
- Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
- Understanding of healthcare claims processing, reimbursement, and benefit administration.
- Ability to interpret medical documentation and apply appropriate coding guidelines.
- Strong attention to detail and analytical skills.
- Excellent written and verbal communication skills.
Preferred Qualifications
- Experience with Third-Party Administrator (TPA) or benefits administration organizations.
- Experience with employer-sponsored health plans and benefits administration.
- Experience reviewing or auditing medical claims from the payer perspective.
- Familiarity with payer policies, medical necessity, and claims adjudication.
- Experience with healthcare claims or benefits administration platforms.
- Knowledge of commercial health insurance or self-funded plans.