Certified Medical Coder - REMOTE

Sierra Solutions; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

Sierra Solutions is seeking experienced Certified Medical Coders specializing in payer-side health care operations. The role focuses on accurate coding across CPT, HCPCS, and ICD-10-CM, with claims review and adherence to payer guidelines.

Ideal candidates will have CPC or CCS certification and hands-on experience with claims processing, benefits administration, and collaboration across claims and clinical teams to ensure compliant, efficient reimbursements.

Qualifications

• Active CPC or CCS certification or equivalent.
• Experience coding in payer, health plan, or reimbursement environments.
• Strong knowledge of ICD-10-CM, CPT, HCPCS.
• Understanding of claims processing and benefits administration.
• Ability to interpret medical documentation and guidelines.

Responsibilities

• Perform and review medical coding activities using CPT, HCPCS, ICD-10-CM.
• Review claims and documentation for coding accuracy and compliance.
• Apply payer-specific coding and reimbursement guidelines.
• Identify and resolve coding discrepancies and billing issues.
• Interpret medical records and employer benefit plans.
• Collaborate with claims, clinical, and operations teams to resolve issues.
• Support auditing, QA, and process improvements.
• Stay updated with coding guideline changes.

Skills

CPC

CCS

payer-side coding

ICD-10-CM

CPT

HCPCS

claims processing

benefits administration

attention to detail

communication skills

Education

Active CPC/CCS certification or equivalent

Job description

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

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.

• 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.