About the Role
The Medical Coding Specialist is responsible for independently reviewing, analyzing, and resolving all assigned front-end scrubs and denied claims to ensure accurate and timely claim payment. This position focuses on identifying and correcting coding-related issues prior to claim submission, resubmitting corrected claims or appealing denied claims, applying established coding guidelines, payer requirements, and organizational policies. The Coding Specialist 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/denials per hour
- Reviews coding and resubmits corrected claims to insurance
- Creates appeal letters/forms with medical documentation
- Maintains a minimum of 92% 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.
- Utilizes 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 Manager.
- Escalates all coding-related questions to the assigned Coding manager 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 Coding Certification for a minimum of 3 years.
- Minimum of 3+ years of professional coding experience.
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
- Prior experience in reviewing front end coding errors before submitting to insurance
- Prior experience in reviewing and correcting coding from insurance denials.
- Prior experience in submitting corrected claims and appeals.
- Prior experience with insurance guidelines and EOBs.
- Familiarity with proper English grammar, usage, and professional documentation standards.
- Ability to research and analyze 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 judgment 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).
We offer competitive benefits to set you up for success in and outside of work.
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, color, 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:
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 px@innovaccer.com. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.
Current AAPC or AHIMA coding certification for 3+ years; 3+ years professional coding experience; knowledge of CPT, ICD-10-CM, medical terminology, Medicare guidelines; experience with front-end coding errors, denials, corrected claims, appeals, insurance guidelines, EOBs; Microsoft Office proficiency.
Key Responsibilities
- reviewing medical codes
- resubmitting corrected claims
- appealing denied claims
Skills & Tools
Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft Teams
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — United States
- Languages: English
Benefits
- Generous paid time off
- Generous parental leave
About Innovaccer
A healthcare technology company providing analytics and software solutions. — Industry: Information Technology