Especialista en Codificación y Reglas de Pago (CPT/ICD-10)

MCS Health; San Juan (PR); On-site; USD 65,000 - 90,000; Full time

Job summary

MCS Healthcare Holdings, LLC is seeking a Coding & Payment Rule Specialist in San Juan, PR to apply coding guidelines (ICD-10, CPT, HCPCS) and CMS payment rules for proper and timely claim processing.

The role requires 3+ years of experience in coding and payment rules, with advanced Spanish and English communication skills; CCS/CCS-P preferred. Work involves collaboration with providers and internal teams to ensure compliant coding and accurate payments.

Qualifications

• Bachelor’s degree in Business Administration.
• 3+ years of experience in coding and payment rules.
• CCS or CCS-P certification preferred.
• Advanced Spanish and English communication skills.

Responsibilities

• Apply coding guidelines (ICD-10, CPT, HCPCS) and CMS payment rules.
• Monitor CMS changes and update internal payment rules accordingly.
• Validate annual coding changes on pre-authorization lists and formulary.
• Review potential coding changes driven by Medicare NCDs and payment rules.
• Educate providers and staff on CPT, ICD-10, HCPCS, DRG, and APC guidelines.

Skills

Spanish (Advanced)

English (Advanced)

Education

Bachelor’s in Business Administration

Associate degree / 60–64 credits in Health Information Technology

CCS or CCS-P certification (preferred)

Tools

Claims editing systems

Job description

MCS Healthcare Holdings, LLC is seeking a Coding & Payment Rule Specialist in San Juan, PR to apply coding guidelines (ICD-10, CPT, HCPCS) and CMS payment rules for proper and timely claim processing.

The role requires 3+ years of experience in coding and payment rules, with advanced Spanish and English communication skills; CCS/CCS-P preferred. Work involves collaboration with providers and internal teams to ensure compliant coding and accurate payments.