Coding Specialist - 1.0FTE

Coding Specialist

Osceola Medical Center is committed to implementing behavior standards as a foundation for how we hire, develop, and retain our team members. By intentionally selecting candidates whose values and behaviors align with these standards, we ensure that our mission is lived out every day, creating an environment where patients feel valued, respected, and confident that OMC is the place for all their healthcare needs.

Schedule: Monday-Friday 40 hours/week

Job Summary: The Coding Specialist is responsible for the accurate and timely assignment of professional (PB) and hospital (HB) medical codes for clinic and hospital encounters using the Epic EMR system. This role ensures compliance with coding guidelines and regulatory requirements while supporting optimal reimbursement and data integrity.

Responsibilities include:

• Assign accurate CPT, ICD-10-CM, and HCPCS codes for both PB and HB encounters based on clinical documentation
• Apply critical thinking to interpret documentation and select appropriate codes when guidelines are complex or ambiguous
• Independently manage and resolve coding-related claim edits and denials in real time, including researching root causes, correcting codes, and submitting appeals as appropriate
• Review medical records to ensure completeness, accuracy, and compliance with coding and billing requirements, including identification of denial risk
• Query providers for clarification or additional documentation to support accurate coding, denial prevention, and reimbursement
• Ensure compliance with federal, state, and payer-specific regulations and guidelines to minimize denials and support audit readiness
• Identify trends in coding errors, edits, and denials; analyze root causes and take proactive steps to prevent recurrence
• Collaborate with providers, billing, and revenue cycle teams to resolve coding-related claim issues and denial trends
• Track, monitor, and follow up on coding-related denials to ensure timely resolution and appropriate reimbursement
• Maintain established productivity and quality benchmarks while effectively managing denial-related workload
• Stay current with coding updates, regulatory changes, and payer requirements impacting coding and denials
• Document coding actions, rationale, and denial research, corrections, and resolutions within the system

Knowledge, Skills, and Abilities:

• In-depth knowledge of PB and HB coding methodologies, guidelines, and regulatory requirements
• Demonstrate critical thinking skills with the ability to analyze complex clinical scenarios and apply appropriate coding logic
• Strong real-time problem-solving ability, including prioritizing work, resolving edits/denials efficiently, and making sound decisions under time constraints
• Understanding of Medicare, Medicaid, and commercial payer coding and reimbursement policies
• Familiarity with clinical documentation standards and medical terminology
• Proficiency with EMR systems (Epic preferred) and coder tools
• Strong attention to detail and commitment to coding accuracy and compliance
• Effective written and verbal communication skills, including provider query best practices
• Ability to prioritize workload, manage denials, and meet productivity standards
• Ability to maintain HIPAA compliance and safeguard confidential information
• Ability to work independently and collaboratively across teams

Physical Requirements for the Role:

• Prolonged sitting and computer use
• Manual dexterity to operate a keyboard and standard office equipment
• Ability to review detailed electronic medical records for extended periods

Work Environment:

• Hybrid office-based and remote work environment
• Limited direct patient interaction; frequent collaboration with providers and revenue cycle teams
• Standard work hours with overtime as needed.

Why Join OMC? At OMC, we don't just hire for skillswe hire for behaviors that align with our mission. We invest in team members who are committed to making a meaningful difference in the lives of our patients and in the communities we serve.

Osceola Medical Center is an equal opportunity employer and is committed to creating an inclusive environment for all employees.