Coder III - Plastics Specialty

Medical Coding Specialist

Major Responsibilities:

Accurately assign all codes (ICD-10-CM/PCS, CPT, HCPCS) for highly complex professional fee encounters (highest complexity level) or moderate to high complexity facility encounters.

Serve as the authoritative internal expert for professional coding guidelines or a knowledgeable resource for facility guidelines. Provide expert guidance, training, onboarding assistance, and mentorship to Coder I/II staff to enhance team performance and accuracy.

Provide informal code review guidance as directed by leadership, focusing purely on the accuracy of code assignment and documentation translation for complex cases.

Review accounts placed on pre-bill hold to address specific coding edits, complex claim issues, and/or denial prevention strategies before final billing.

Master and interpret complex regulatory updates and official coding guidelines (e.g., AHA Coding Clinic), translating changes into actionable processes for the team.

Licensure, Registration, and/or Certification Required:

Coding Certification issued by:

• Academy of Coders (AAPC), OR
• American Health Information Management Association (AHIMA);
• Dual Certifications preferred

Education Required:

• Associate's Degree in Health Information Management or equivalent experience/advanced training beyond High School in Medical Coding required

Experience Required:

• Minimum of 5+ years of extensive medical coding experience, with significant experience in complex professional, inpatient, or outpatient facility coding.
• Experience with Epic or similar electronic health record systems is required

Knowledge, Skills & Abilities Required:

• Mastery of medical terminology, anatomy, physiology, and complex pathophysiology for multiple service lines/specialties/types
• Expert knowledge of official coding guidelines, regulatory requirements, and comprehensive reimbursement models (DRG, RVU)
• Exceptional analytical skills to manage the highest level of coding complexity in professional coding and moderate to high complexity in facility coding
• Strong attention to detail and the ability to work independently to solve complex coding problems and interpret nuanced rules
• Strong communication and interpersonal skills to effectively mentor staff and interact with support teams
• Ability to meet deadlines while working in a fast-paced environment and take initiative in a collaborative environment

Supervisory and Management Responsibilities:

• This is a highly advanced, expert individual contributor role. It assumes "lead" responsibilities in expertise, mentoring, and informal quality checks but has no formal management responsibility

Physical Requirements and Working Conditions:

• Exposed to normal office environment in a remote work setting
• Job may require occasional travel for training or meetings, therefore, may be exposed to road and weather hazards
• May need to be able to lift up to 40 lbs. occasionally (e.g., equipment)
• Sits the majority of the workday, but also may lift, reach, and bend throughout the day
• Operates all equipment necessary to perform the job

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.