Medical Coder III

Decypher; United States; Remote; USD 40,000 - 48,000; Full time

Job summary

Decypher is hiring a remote Medical Coder III to join our team supporting healthcare coding operations. You will apply advanced coding knowledge to ensure accurate reimbursement, regulatory compliance, and ongoing process improvements across institutional and professional coding settings. Applicants should have extensive ICD-CM/PCS, CPT, HCPCS expertise, strong understanding of DRGs and APCs, and experience with EHR workflows.

U.S. citizenship is required.

Qualifications

• Five years of medical coding and/or auditing experience in two or more specialties within past 10 years.
• OR three years of medical coding/auditing in a Military Treatment Facility.
• Minimum one year in specialty; inpatient coding required.

Responsibilities

• Advanced knowledge of ICD-CM/PCS, HCPCS, CPT used in institutional and professional coding.
• Knowledge of reimbursement systems including PPS, DRGs, APCs, and RBRVS.
• Understanding of medical terminology, anatomy, physiology, pharmacology, and disease processes.
• Experience with government rules and regulations for coding and reimbursement and risk areas for fraud/abuse.
• Experience with clinical documentation improvement and EHR workflows related to coding.

Skills

ICD-CM/PCS/CPT

Medical coding

Auditing

Reimbursement knowledge

Regulatory compliance

Education

AS/AA in Health Information

Healthcare Administration certificate

AHIMA/AAPC training in coding

Tools

EHR systems

DRGs/APCs knowledge

CMS guidelines knowledge

Job description

Join Decypher and make a direct impact on the health and readiness of America's service members, veterans, and their families. Since 2008 Decypher has offered healthcare industry professionals careers where their expertise is valued, and their work makes a meaningful impact. Decypher partners with the Defense Health Agency to deliver professional services, technology, and management solutions. Our mission is to provide and support quality care for our veterans, servicemembers and their families, across the United States and overseas.

Pay Rate: $28.98 to $35 per hour + H&W

Job Summary

Medical Coder III is a senior coding role requiring advanced expertise in ICD-CM, ICD-PCS, CPT, HCPCS, reimbursement methodologies, and medical coding regulations to accurately support institutional and professional healthcare coding operations. In this role, you will have the opportunity to apply your knowledge of clinical documentation, healthcare compliance, revenue cycle management, EHR workflows, and coding audit principles to ensure accurate reimbursement, regulatory compliance, and continuous process improvement.

Required Qualifications

Required Experience

• Five (5) years of medical coding and/or auditing experience in two (2) or more medical, surgical, and ancillary specialties within the past 10 years;
• OR
• Three (3) years of medical coding or auditing experience if that experience was in a Military Treatment Facility.
• A minimum of one (1) year of performance in the specialty is required to be documented to be considered qualifying. Inpatient coding is required.

Education: Completion of ONE of the following

• Associate's Degree or higher in any of these areas:

• Health Information,

• Healthcare Administration OR

• Biological Science

• OR a University Certificate in medical coding

• OR at least 30 semester hours university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, or pharmacology

• OR Successful completion of American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology.

• OR Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision

Certification: Must have one certification from each group for a total of 2 certifications

Professional Certification

• AAPC CPC
• AHIMA CCS-P

Institutional Certification Professional

• AAPC CIC
• AHIMA CCS

or Institutional Certification

• AIHMA RHIA
• AHIMA RHIT

Note

A Registered Health Information Technician (RHIT) and Registered Health Information Administrator (RHIA) from AHIMA may be counted towards either the professional services or institutional coding certification requirement, but not both unless the individual possesses the required institutional and professional services experience for the specific position sought. You are welcome to apply if you are not sure you meet this qualification - we will review your experience and let you know.

Medical Coding Test

minimum 80% passing score

Key Responsibilities

• Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT), as used in institutional and professional services medical coding.
• Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to: Laboratory, Dental, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts related to medical coding.
• Practical knowledge and understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.
• Practical knowledge of clinical documentation improvement and continuous process improvement processes.
• Practical knowledge of EHR systems and workflows pertaining to medical coding.

U.S. Citizenship is required.

Work Environment and Schedule

• 100% Remote
• Flexible scheduling Sunday--Saturday
• Up to 40 hours per week

Compensation and Benefits

$28.98 to $35 per hour + H&W

Physical requirements

May be required to lift 20-25 pounds independently. Position requires long periods of sitting, and the ability to use a computer.

We are currently hiring remote medical coders in

AK,AL,AR,AZ,CA,CO,FL,GA,HI,IL,IN,KS,LA,MD,ME,MO,MS,NC,NE,NM,NV,OH,OK,SC,TN,TX,UT,VA,WA

Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)