721 Certified Coding Specialist jobs in the United States

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

This is a remote based position

Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects.

Job Description:

Essential Duties & Responsibilities including but not limited to:

Coding Responsibilities:

1. Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.

2. Periodic review of codes, at least annually or as introduced or required.

3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.

4. Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.

5. Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.

6. Maintains certification requirements for coding.

Follow Up Responsibilities:

1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.

2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers' issues, retrieving critical information that impacts the resolution of current or potential future claims.

3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.

4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.

5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.

6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.

7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.

8. Reviews/updates all accounts for write-offs and refunds.

9. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients' portion due.

10. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.

11. Handles incoming department mail as assigned.

12. Attends meetings and serves on committees as requested.

13. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.

14. Provides and promotes ideas geared toward process improvements within the Central Billing Office.

15. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.

16. Completes projects and research as assigned.

17. Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.

Secondary Functions:

1. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.

2. Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.

3. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.

4. Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.

5. Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.

6. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.

7. Assists other staff as required in the completion of daily tasks or special projects to support the department's efficiency.

8. Performs similar or related duties as assigned or directed.

Education & Professional Development:

1. Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD's), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.

2. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.

3. Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.

Organizational Requirements:

1. Maintain strict adherence to the Lahey Health Confidentiality policy.

2. Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.

3. Comply with all Lahey Health Policies.

4. Comply with behavioral expectations of the department and Lahey Health.

5. Maintain courteous and effective interactions with colleagues and patients.

6. Demonstrate an understanding of the job description, performance expectations, and competency assessment.

7. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.

8. Participate in departmental and/or interdepartmental quality improvement activities.

9. Participate in and successfully completes Mandatory Education.

10. Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate

Licensure, Certification & Registration: CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)

Experience: 1-2 years of experience in billing, coding, denial management environment related field.

Skills, Knowledge & Abilities:

• Ability to work independently and take initiative

• Good judgment and problem solving skills

• Excellent organizational skills

• Ability to interact and collaborate effectively and tactfully with staff, peers and management.

• Ability to promote team work through support and communication.

• Ability to accept constructive feedback and initiate appropriate actions to correct situations.

• Ability to work with frequent interruptions and respond appropriately to unexpected situations.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

Adhere to internal system-wide policies, competencies, behaviors and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements. Utilize advanced, spec Coding Specialist, Certified, Specialist, Healthcare, Billing

Description

Summary

The Certified Coding Specialist protects and recovers the clinic’s patient reimbursement by acting as a coding/billing resource for all MWU clinics, educating providers, monitoring accounts receivable, and collecting delinquent accounts. This position will report to the Assistant Manager of Patient Accounts.

Essential Duties and Responsibilities:

• Reviews coding used for Multispecialty Clinics and Eye Institute to ensure coding is in accordance with legal requirements, compliance standards, official coding rules, guidelines and definitions

• Review electronic health records (EHR) to determine what information is appropriate for coding purposes

• Participate in provider education on proper documentation of services provided, coding and billing issues, charge capture process and reconciliation of charges as it relates to E & M coding guidelines

• Train and educate finance staff on billing and coding

• Participate in clinic coding assessments/audits, both internal and with external vendors

• Participate in the development of coding policies and procedures as needed

• Identify key issues and take appropriate action to ensure revenue maximization on individual accounts

• Ensure all documentation (ABNs, letters of medical necessity, Medicare Wellness forms, etc.) are on file and properly filled out for patients when required

• Research coding/billing guidelines for new specialties

• Work in conjunction with the Assistant Manager and Manager of Patient Accounts to help reach and maintain financial and accounts receivable goals for the clinic

• Assist in implementing changes directed by regulatory agencies

• Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, and participating in professional organizations

• Other duties may be assigned

Supervisory Responsibilities

This position has no supervisory responsibilities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Must be able to work in a constant state of alertness and safe manner and have regular, predictable, in-person attendance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Qualifications

The position requires strict compliance with all policies and procedures. This position requires a significant amount of interaction with the public and many internal customers and therefore, the individual must be able to develop positive rapport effectively.

Education and/or Experience

High school diploma or GED required. Associate degree preferred. A minimum of 3-5 years of coding experience in a medical office setting and a current Certified Professional Coder (CPC) certification required. Expert knowledge of ICD-10, CPT, HCPCS, modifiers, and medical terminology required. Experience working with Medicare, Medicaid, Third party payers is also required. Expert in interpreting LCD and NCD coverage criteria. Knowledge of the revenue cycle, charge master, manual book coding/computer coding experience. Excellent interpersonal, communication and customer service skills are required. Strong analytical and problem solving skills. Excellent verbal and written communication skills are a must. Must be able to work independently and multi-task working on several projects at once.

Computer Skills

Computer proficiency in MS Office (Word, Excel, Outlook) is required. Experience using medical practice management software is required.

Language Skills

Intermediate skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Reasoning Ability

Basic skills: Ability apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Mathematical Ability

Basic skills: Ability to add, subtract, multiply, and divide all units of measure using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to interpret bar graphs.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit, talk and hear. The employee must regularly use hands to handle or feel and reach with hands and arms. The employee is occasionally required to stand and walk. The employee must frequently lift and /or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Midwestern University is a private, not-for-profit organization that provides graduate and post-graduate education in the health sciences. The University has two campuses, one in Downers Grove, Illinois and the other in Glendale, Arizona. More than 6,000 full-time students are enrolled in graduate programs in osteopathic medicine, dentistry, pharmacy, physician assistant studies, physical therapy, occupational therapy, nurse anesthesia, cardiovascular perfusion, podiatry, optometry, clinical psychology, speech language pathology, biomedical sciences and veterinary medicine. Over 500 full-time faculty members and 400 staff members are dedicated to the education and development of our students in an environment that encourages learning, respect for all members of the health care team, service, interdisciplinary scholarly activity, and personal growth.

We offer a comprehensive benefits package that includes medical, dental, and vision insurance plans as well as life insurance, short/long term disability and pet insurance. We offer flexible spending accounts including healthcare reimbursement and child/dependent care account. We offer a work life balance with competitive time off package including paid holiday’s, sick/flex days, personal days and vacation days. We offer a 403(b) retirement plan, tuition reimbursement, child care subsidy reimbursement program, identity theft protection and an employee assistance program. Wellness is important to us and we offer a wellness facility on-site with a fully equipped fitness facility.

Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate against an employee or applicant based upon race; color; religion; creed; national origin or ancestry; ethnicity; sex (including pregnancy); gender (including gender expressions, gender identity; and sexual orientation); marital status; age; disability; citizenship; past, current, or prospective service in the uniformed services; genetic information; or any other protected class, in accord with all federal, state and local laws, and regulation. Midwestern University complies with the Smoke-Free Arizona Act (A.R.S. ) and the Smoke Free Illinois Act (410 ILCS 82/). Midwestern University complies with the Illinois Equal Pay Act of 2003 and Arizona Equal Pay Acts.

#MidwesternUniversityJobs

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Qualifications

Education

Required

• High School or better

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights ( notice from the Department of Labor.

Join a dedicated healthcare team in the Midwest region as a Certified Coding Specialist, where your expertise in medical coding will directly impact patient care and reimbursement accuracy. This role involves applying ICD-10-CM, CPT, and modifier codes to patient records using advanced coding software, ensuring compliance with ethical standards and official guidelines.

Key Responsibilities

• Assign accurate medical codes to inpatient and outpatient services based on healthcare documentation.
• Maintain a coding accuracy rate of 95% or higher while managing workload independently.
• Communicate effectively with providers to resolve coding issues and submit queries as needed.
• Serve as a resource for coding questions and assist billing offices in resolving edits.
• Adhere to HIPAA regulations to protect patient information.
• Foster professional relationships with patients, providers, and team members to support quality care delivery.

• Required: Valid coding credential such as CPC, COC, CCS, CCS-P, RHIT, or RHIA.
• Preferred: Associate's Degree with 2+ years of coding experience in healthcare or professional fee coding.
• Experience in auditing coding accuracy and educating coding staff is a plus.

• Strong knowledge of inpatient and professional ICD-10-CM and CPT coding standards.
• Proficient with medical records systems and coding software.
• Excellent organizational, communication, and interpersonal skills.
• Ability to prioritize tasks efficiently and work towards goals independently.

Join a dynamic healthcare team in the Midwest region as a skilled Coding Specialist focused on Health Information Management. In this role, you will meticulously review clinical documentation and diagnostic results to extract data and assign accurate ICD-10 CM, ICD-10-PCS, and CPT/HCPCS codes for billing, reporting, research, and regulatory compliance. Your expertise will cover a variety of hospital coding areas including Ancillary, Emergency Department, Inpatient, Outpatient Surgery, Obstetrics, Infusion, and Long Term Care.

Key Responsibilities

• Adhere to the ethical coding standards established by the American Health Information Management Association (AHIMA) and follow official coding guidelines.
• Apply ICD-10 CM diagnosis and ICD-10-PCS procedure codes to accurately represent patient visit documentation, identifying relevant MS-DRG and APR-DRG classifications that impact reimbursement.
• Maintain effective communication and collaboration with physicians, clinical staff, and billing teams to ensure accurate coding and satisfactory reimbursement outcomes.
• Utilize coding software and resources to code inpatient services, including procedures and diagnoses, while abstracting required data elements such as present on admission (POS) and discharge status.
• Communicate coding issues and queries effectively with providers and Clinical Documentation Improvement Specialists to ensure documentation supports accurate coding and revenue capture.
• Serve as a resource for coding questions and billing edit resolutions, managing your coding workload independently while applying complex coding principles.
• Comply with HIPAA regulations to protect patient health information confidentiality.
• Maintain a coding accuracy rate of 95% or higher and meet productivity standards based on patient classifications.

• Advanced knowledge of Anatomy and Physiology, Medical Terminology, Pharmacology, and ICD-10 CM/PCS coding.
• Proven ability to apply Complications and Co-Morbidity (CC) and Major Complication/Co-Morbidity (MCC) conditions.
• Understanding of POA requirements, DRG, MS-DRG, and APR-DRG systems, including severity of illness and risk of mortality.
• Successful completion of courses in Anatomy and Physiology, Medical Terminology, basic ICD-10-CM/PCS coding, and CPT coding.
• Minimum of 2 years experience in Health Information Management, medical office, or healthcare environment.

• ICD-10 education and training.
• Three years of hospital inpatient coding experience.

• Must obtain professional coding certification within one year of employment.
• Preferred certifications include CCS, CCS-P, CPC, CPC-H, RHIT, or RHIA.

• Integrity: Demonstrates honesty and ethical behavior, inspiring others to uphold organizational values.
• Compassion: Exhibits empathy and excellent customer service, managing conflict with professionalism.
• Accountability: Takes ownership of projects and adapts flexibly to changing priorities.
• Respect: Collaborates effectively with diverse populations, maintaining a positive service orientation.
• Excellence: Strong communication and leadership skills, capable of guiding teams and facilitating process improvements.

• Health: Medical, Dental and Vision plans available for qualifying staff and family
• Holiday, Vacation and Sick Leave
• Education discount for staff and dependents (undergraduate only)
• Retirement: Up to 10% matched contribution from UAMS
• Basic Life Insurance up to $50,000
• Career Training and Educational Opportunities
• Merchant Discounts
• Concierge prescription delivery on the main campus when using UAMS pharmacy

• High School Diploma/GED.
• Must have an understanding of CPT and ICD-10.
• One of the following certifications: CCA, CCS, CPC, RHIT or RHIA.

• Associate's or Bachelor's in Health Information Management.
• Two (2) years of coding experience.

• Assesses the adequacy of the health record documentation to ensure it supports all diagnoses and procedures to which codes are assigned.
• Applies knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures.
• Maintains understanding of ICD-10 and CPT coding classification systems.
• Reviews and performs data charge entries to both hospital and physician patient accounting systems for the outpatient clinic visit.
• Organizes work to ensure all assigned work queues are reviewed and appropriately prioritized on a daily basis.
• Performs other duties as assigned.