Medical Coding Specialist

Innovaccer Analytics; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Paid time off

Parental leave

Recognition program

Insurance coverage

Job summary

Innovaccer Inc. seeks a Medical Coding Specialist to independently review, analyse, and resolve front-end claims for accurate submissions. You will apply CPT/ICD-10-CM guidelines, review docs, and ensure medical necessity.

The role supports clean claim rates and compliant coding in a fast-paced environment. Requirements include a current AAPC/AHIMA certification, 3+ years coding experience, strong terminology knowledge, and HIPAA compliance.

Qualifications

• Current AAPC or AHIMA certification for at least 3 years.
• Strong CPT and ICD-10-CM knowledge with modifiers.
• Proficient English grammar and medical terminology.
• Ability to review records and resolve coding issues.
• HIPAA compliance and confidentiality experience.

Responsibilities

• Review front-end claims and assign ICD-10-CM and CPT codes with modifiers.
• Review medical records to determine appropriate codes for services.
• Ensure all diagnosis codes meet local and national medical necessity guidelines.
• Maintain coding accuracy and resolve front-end claim holds independently.
• Participate in department meetings and communicate with Coding Team Lead.
• Escalate coding trends and questions to the Coding Team Lead.

Skills

AAPC/AHIMA certification

CPT/ ICD-10-CM knowledge

Medical terminology

Anatomy & physiology

Medicare guidelines

Microsoft Office

Analytical ability

Communication

HIPAA/compliance

3+ years coding experience

Tools

Microsoft Office

Job description

About the Role

The Medical Coding Specialist is responsible for independently reviewing, analysing, 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 organisational policies. The Medical Coder 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.
• Utilises 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 analyse 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 judgement 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.

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, colour, 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)

Disclaimer:

Innovaccer does not charge fees or require payment from individuals or agencies for securing employment with us. We do not guarantee job spots or engage in any financial transactions related to employment. If you encounter any posts or requests asking for payment or personal information, we strongly advise you to report them immediately to our HR department at [e-mail]. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.

About Innovaccer?

Innovaccer activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health, Atlantic Health, and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure? extending the human touch in healthcare. For more information, visit www.innovaccer.com.