Senior Medical Coder

The Judge Group; United States; On-site; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare consulting firm is seeking a Senior Medical Coder to be the subject matter expert on medical coding. The role includes analyzing coding guidelines, reviewing medical records, and ensuring compliance with regulations. Candidates should have over 10 years of medical coding experience, strong knowledge of HIPAA compliance, and excellent leadership skills. This position requires collaboration with technical teams to enhance revenue optimization and maintain coding integrity.

Qualifications

• 10+ years of medical coding experience required.
• Certification in medical coding and/or fraud investigations preferred.

Responsibilities

• Act as the company expert on billing codes and code-edit content.
• Analyze and apply coding guidelines to product solutions.
• Develop code-editing strategies using AI technology.
• Review and assign ICD-10-CM and ICD-10-PCS codes.
• Maintain HIPAA compliance and adhere to regulations.

Skills

Healthcare or insurance industry processes understanding

HIPAA compliance

Claims adjudication

Payment integrity

Medical coding tools

Excellent communication skills

Leadership skills

Ability to lead teams

Education

Bachelor’s degree or Associate degree

Tools

EMR/EHR workflows

Code-editing tools

Job description

Hours of Operation

Flexible scheduling required to support global operations. Employees may need to attend pre-scheduled meetings and collaborate with international partners outside normal work hours, including occasional weekends.

About the Role

We are seeking a Senior Medical Coder to serve as the company’s subject matter expert on medical coding and code-edit content. This role ensures accurate and timely implementation of diagnosis, procedure, and episode-of-care codes to maintain compliance and optimize reimbursement integrity. Responsibilities include staff management, quality assurance, compliance monitoring, and collaboration across teams to enhance payment accuracy and revenue optimization.

Responsibilities

• Act as the company expert on billing codes and code-edit content, updates, and applications.
• Analyze, validate, and apply coding guidelines to product solutions.
• Stay current with CMS coding guidelines for inpatient and outpatient services.
• Validate CMS-related code edits within proprietary solutions.
• Develop code-editing strategies using advanced AI technology in collaboration with technical teams.
• Review and analyze patient medical records to accurately assign ICD-10-CM and ICD-10-PCS codes.
• Ensure accurate code assignment for diagnoses, procedures, and modifiers.
• Group diagnoses into MS-DRG and apply POA indicators for inpatient encounters.
• Understand and apply code assignments that may trigger Patient Safety Indicators (PSI).
• Maintain HIPAA compliance and adhere to CMS and OIG regulations.
• Ensure compliance with federal, state, and local laws, as well as company policies and ethical standards.

Required Skills and Knowledge

Industry Expertise:

• Strong understanding of healthcare or insurance industry processes, including:
• HIPAA compliance and healthcare data protection.
• Claims adjudication, EMR/EHR workflows.
• Payment integrity and claims processing (835/837 formats).
• Medical coding and code-editing tools.
• Provider network management and credentialing.
• Fraud detection and SIU processes.

Interpersonal & Leadership:

• Excellent written and verbal communication skills.
• Ability to build relationships across organizational levels.
• Strong listening and feedback skills.
• Proven ability to lead teams, set expectations, and drive accountability.
• Ethical decision-making and advocacy for team members.

Technical Knowledge:

• Familiarity with security standards (HiTrust, SOC2, HIPAA).
• Ability to develop expertise in proprietary solutions within 6 months.

Education & Experience

• Bachelor’s degree or Associate degree with 10+ years of medical coding experience.
• Certification in medical coding and/or fraud investigations preferred.