Medical Coder

Medical Coder

Position Summary

The Medical Coder is responsible for ensuring the accurate and compliant coding of professional healthcare services across Hope Network. This role reviews clinical documentation, assigns appropriate CPT, HCPCS, ICD-10, and Evaluation & Management (E/M) codes, and ensures all coding meets payer-specific requirements and national coding guidelines. The Medical Coder works closely with providers and the Revenue Cycle team to resolve coding discrepancies, reduce claim denials, improve reimbursement accuracy, and support efficient billing operations.

Key Responsibilities

Medical Coding & Documentation Review

• Review clinical documentation and assign accurate CPT, HCPCS, ICD-10, and E/M codes for professional services.
• Ensure all coding complies with national coding standards, payer requirements, and Hope Network policies.
• Apply appropriate modifiers and verify correct place of service (POS) coding.
• Maintain current knowledge of CPT, HCPCS, ICD-10, and reimbursement guidelines.

Provider Collaboration

• Query providers regarding documentation deficiencies identified through pre-bill audits.
• Collaborate with providers to clarify documentation and recommend appropriate code selection or downcoding when necessary.
• Provide coding guidance and education to providers and staff across Hope Network locations.

Revenue Cycle & Claims Management

• Review and resolve coding-related claim edits, denials, and payer rejections.
• Submit SAL change requests to correct billing information, including place of service, contact type, and attendance.
• Assist billing staff with coding questions on outstanding accounts to improve reimbursement and collections.
• Support reviews of overpayments and reimbursement discrepancies.

Reporting & Process Improvement

• Analyze coding reports to identify trends related to CPT codes, diagnosis codes, modifiers, and documentation.
• Compile coding statistics and prepare reports for the Revenue Management Director.
• Present coding findings and trends to Business Directors as needed.
• Support billing office workflows and identify opportunities to improve coding accuracy and operational efficiency.

Additional Responsibilities

• Complete assigned projects and special initiatives related to coding and revenue cycle operations.
• Travel to Hope Network locations as needed to provide coding support and assistance.
• Maintain regular and reliable attendance.

Qualifications

Education & Certifications

• Associate's degree in Business, Finance, Health Administration, or a related field, or an equivalent combination of education and experience.
• Current professional coding certification (CPC, CCS-P, or equivalent) from a nationally recognized organization.
• Strong understanding of CPT, HCPCS, ICD-10, and Evaluation & Management (E/M) coding.

Experience

• 2–4 years of professional medical coding experience.
• Experience coding professional healthcare services, including E/M coding, required.
• Knowledge of healthcare billing, reimbursement, and revenue cycle processes preferred.

Knowledge, Skills & Abilities

• Advanced knowledge of CPT, HCPCS, ICD-10, modifiers, and payer-specific coding requirements.
• Ability to interpret clinical documentation and apply accurate coding principles.
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office, electronic billing systems, and healthcare software.
• Ability to prioritize multiple responsibilities while maintaining a high level of accuracy.
• Ability to work collaboratively with providers, billing staff, leadership, and cross-functional teams.
• Valid driver's license with the ability to travel between Hope Network locations as needed.
• Commitment to supporting Hope Network's mission and values through quality, compliant coding practices.

Equal Opportunity Employer


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