Professional, Certified Coding Integrity

The Wright Center for Graduate Medical Education; Scranton (Lackawanna County); On-site; USD 50,000 - 70,000; Full time

Job summary

The Wright Center for Graduate Medical Education in Scranton, PA, is seeking a Certified Coding Integrity Professional. This full-time position involves coding and billing for inpatient and outpatient claims. The ideal candidate will perform accurate coding, manage claims processes, and communicate with providers on billing issues.

The role requires strong knowledge of billing regulations, medical terminology, and coding systems. Candidates should have a degree in a healthcare field and relevant certifications, preferably including CPC.

Qualifications

• Bachelor’s degree or equivalent experience in healthcare.
• Certified Professional Coder or 5 years of professional coding experience.
• Strong knowledge of ICD-10 and billing processes.

Responsibilities

• Perform multi‑specialty coding for claims submission.
• Prepare and submit clean claims to third-party payers.
• Audit daily billing summaries for quality and documentation support.
• Respond to inquiries from patients and payers regarding claims.

Skills

ICD-10 knowledge

CPT/HCPCS coding

Medical terminology

Billing processes

Team leadership skills

Verbal and written communication

Education

Bachelor’s or Associate’s degree in healthcare-related field

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Certified Professional Compliance Officer (CPCO)

Tools

Microsoft Office

Medent

Job description

The Certified Coding Integrity Professional is responsible for all aspects of coding and billing of inpatient & outpatient claims, as well as CCM billing. The role facilitates coding, manages the claims process, ensures accurate and timely claim creation and follow-up, and communicates with providers, insurers, and patients on coding issues. The incumbent also assists in process improvements to maximize revenue and is onsite at clinical locations.

Job Type

Full-time

Responsibilities

• Perform accurate and timely multi‑specialty coding for daily claims submission.
• Prepare and submit clean claims to third‑party payers and work closely with clinical team members regarding appeals, denials, and resolution.
• Audit daily billing summaries to review clinical documentation and coded data for quality and documentation support.
• Respond promptly to account inquiries from patients, payers, providers, and staff on claim submission.
• Interact with physicians, learners and other providers on billing and documentation policies, procedures, and regulations to ensure charges are captured and clarified.
• Perform and monitor all billing and coding steps to maximize reimbursement from patients, payers and special arrangements.
• Assist in provider and learner education to ensure coding quality.
• Participate in clinical huddles, didactics and other meetings as requested.
• Implement and maintain billing and coding educational materials for provider and learner training.
• Implement and maintain population management learner training programs addressing inpatient/outpatient chart review.
• Serve as a resource for all billing and coding matters.
• Understand FQHC coverage, coding, billing and reimbursement, as well as other third‑party payers.
• Understand Medicare, Medicaid and other commercial payer rules and regulations applicable to billing/coding.
• Understand considerations of coding in value‑based payment contracts.
• Review and implement changes from payer bulletins.
• Follow coding/billing guidelines and legal requirements to ensure compliance with federal and state regulations.
• Coach and mentor the billing and education teams.
• Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.

Qualifications

• Bachelor’s or Associate’s degree in a healthcare‑related field or equivalent experience.
• Certified Professional Coder (CPC) or five years of direct professional coding experience (CPC, CRC, CPCO certifications are a plus).
• Strong knowledge of ICD‑10, CPT/HCPCS coding, medical terminology, and billing processes.
• Knowledge of medical billing/EHR systems (preferably Medent).
• Knowledge of EOBs, EFTs and ERAs.
• Knowledge of Microsoft Office software.
• Team leadership skills with a positive disposition.
• Self‑directed, organized and able to solve problems.
• Accurate attention to detail.
• Excellent verbal and written communication skills.

Licenses and Certifications

• Certified Professional Coder – CPC (preferred).
• Certified Risk Adjustment Coder – CRC (preferred).
• Certified Professional Compliance Officer – CPCO (preferred).
• FQHC billing experience helpful.
• General working knowledge or prior exposure to healthcare environments, auditing concepts, medical billing/operations, medical terminology and clinical documentation.