Coding Specialist-I

Innovaccer Analytics; United States; Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Paid time off

Parental leave

Recognition & rewards

Insurance coverage

Job summary

Innovaccer Inc. is seeking a Coding Specialist I to review, analyze, and resolve front-end claims for accurate submission. You will apply CPT/ICD-10-CM codes, assess medical necessity, and work with revenue cycle partners to minimize rejections.

Strong attention to detail, independent judgment, and knowledge of HIPAA are essential. This role requires 3+ years of coding experience and AAPC/AHIMA certification, with proficiency in Microsoft Office.

Qualifications

• 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 Medicare 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 and apply policies, procedures, laws, and regulations.
• Ability to read medical documentation and interpret procedures.

Responsibilities

• Review, analyze, and resolve front-end claims to ensure accurate submission.
• Apply coding guidelines and payer requirements to prevent rejections.
• Collaborate with revenue cycle partners to improve clean claim rates.
• Review medical records to determine appropriate codes for services and diagnoses.
• Ensure all diagnosis codes meet medical necessity guidelines.
• Use internal resources to ensure compliant coding for all services.
• Follow HIPAA regulations and maintain confidentiality.
• Maintain current knowledge of relevant laws, regulations, and payer policies.
• Mentor with Coding Team Lead and participate in meetings.
• Escalate coding questions or client trends to leadership.
• Complete CEU requirements and perform additional duties as assigned.

Skills

CPT & ICD-10-CM coding

Medical terminology

Anatomy & physiology

Medicare guidelines

Data analysis

Policy interpretation

Independent judgment

Communication

HIPAA compliance

Microsoft Office

Education

AAPC/AHIMA Certification

Tools

Microsoft Office

Job description

About the Role

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.

A Day in the Life

• 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.

What You Need

• 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.

We offer competitive benefits to set you up for success in and outside of work.

Here's What We Offer

• Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays- because we believe work-life balance fuels performance.
• Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry's most generous parental leave policies to support you during life's most important moments.
• Recognition & Rewards: We celebrate wins - big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won't go unnoticed.
• Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

Innovaccer Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. Innovaccer Inc. participates in the E-Verify program to confirm employment eligibility of all newly hired employees based out of the U.S. and employed by Innovaccer Inc.

For any additional information, please visit the below websites:

E-Verify

Right to Work (English)

Right to Work (Spanish)