Coding Specialist- CPC

CADUCEUSHEALTH®; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

CADUCEUSHEALTH® is seeking a Coding Specialist I to review, analyze, and resolve front-end claims for accurate submission. This role focuses on identifying coding issues before transmission and applying established guidelines and payer requirements.

You will collaborate with revenue cycle partners to prevent rejections, maintain high coding accuracy, and stay current with HIPAA rules while working in a fast-paced environment.

Qualifications

• Current AAPC or AHIMA certification with at least 3 years of professional coding experience.
• Strong CPT and ICD-10-CM knowledge and Medicare reimbursement guidelines.
• Excellent written and verbal communication and ability to work independently.
• Experience in medical billing and HIPAA compliance.

Responsibilities

• Review front-end claims to determine codes before transmission.
• Maintain at least 90% coding accuracy.
• Assign ICD-10-CM and CPT codes with modifiers for professional services.
• Ensure documentation meets medical necessity guidelines.
• Resolve front-end claim holds and escalate trends as needed.
• Adhere to HIPAA and protect patient information.
• Participate in team meetings and mentorship sessions.

Skills

AAPC/AHIMA cert

CPT coding

ICD-10-CM

Medical terminology

Anatomy & physiology

Medicare guidelines

HIPAA compliance

Microsoft Office

Tools

Microsoft Office Suite

Job description

The Coding Specialist I is responsible for independently reviewing, analyzing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Coding Specialist I 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.

Essential Functions:

• Averages 10 front-end holds per hour
• Maintains a minimum of 90% 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 Team Lead.
• Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification.
• Maintains and completes all CEU requirements.
• Performs other duties or tasks as assigned.

PREFERED SKILLS & EXPERIENCE

• Must hold a current AAPC or AHIMA Certification for a minimum of 3 years.
• Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
• Familiarity with proper English grammar, usage, and professional documentation standards.
• Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues.
• Ability to read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures.
• Demonstrated ability to exercise independent judgment in coding and claim resolution.
• Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff.
• Strong commitment to maintaining confidentiality and safeguarding protected health information.
• Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements.
• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams).
• Minimum of 3+ years of professional coding experience.