We are seeking an experienced and detail-oriented Certified Medical Coder with strong EPIC EMR experience and expertise in Primary Care and/or Urgent Care coding. The Certified Medical Coder will be responsible for reviewing clinical documentation, assigning accurate diagnosis and procedure codes, ensuring coding compliance, and supporting optimal reimbursement while adhering to federal regulations, payer requirements, and industry best practices.
The ideal candidate possesses a strong understanding of ICD-10-CM, CPT, HCPCS, and Evaluation & Management (E&M) coding guidelines, along with the ability to work efficiently in a fast-paced outpatient environment. This role plays a critical part in maintaining coding accuracy, improving documentation quality, minimizing denials, and supporting overall revenue cycle performance.
Key Responsibilities
- Review and accurately assign ICD-10-CM, CPT, HCPCS, and applicable modifier codes for Primary Care and Urgent Care encounters.
- Analyze clinical documentation to ensure services rendered are appropriately documented and coded according to current coding guidelines.
- Validate Evaluation & Management (E&M) service levels using current CMS, AMA, and payer-specific requirements.
- Perform coding quality reviews and audits to ensure documentation supports billed services and reimbursement.
- Identify, investigate, and resolve coding discrepancies, documentation deficiencies, claim edits, and coding-related denials.
- Collaborate with physicians, advanced practice providers, and clinical staff to obtain documentation clarification and improve coding accuracy.
- Provide coding guidance, education, and feedback to providers and staff regarding documentation and coding best practices.
- Monitor denial trends and recommend corrective actions to reduce future coding-related denials and payment delays.
- Apply payer-specific coding and billing requirements to support clean claim submission and reimbursement optimization.
- Stay current on changes to ICD-10-CM, CPT, HCPCS, CMS regulations, and commercial payer policies.
- Ensure compliance with HIPAA, federal and state regulations, payer requirements, and organizational policies.
- Support revenue cycle initiatives focused on improving coding accuracy, charge capture, claim acceptance rates, and reimbursement outcomes.
- Participate in internal and external coding audits and assist with audit responses and corrective action plans when necessary.
- Maintain productivity, quality, and accuracy standards while meeting established coding turnaround times.
- Document coding decisions and maintain records of coding reviews, corrections, and provider communications.
- Contribute to continuous process improvement initiatives related to coding operations and revenue cycle performance.
Qualifications
- 5+ years of professional medical coding experience.
- Experience conducting coding audits and quality assurance reviews.
- Experience providing coding education and documentation feedback to providers.
- Familiarity with Medicare, Medicaid, and commercial payer policies.
- Multi-specialty outpatient coding experience.
- Knowledge of revenue cycle management processes and denial prevention strategies.
- Current coding certification in one of the following:
- CPC (Certified Professional Coder)
- CCS-P (Certified Coding Specialist – Physician-Based)
- COC (Certified Outpatient Coder)
- Minimum of 3 years of professional medical coding experience.
- Hands-on experience using EPIC EMR.
- Strong knowledge of:
- ICD-10-CM
- CPT
- HCPCS
- Evaluation & Management (E&M) coding guidelines
- Experience coding for Primary Care and/or Urgent Care services.
- Thorough understanding of payer guidelines, medical necessity requirements, and coding compliance standards.
- Strong analytical, problem-solving, and critical-thinking skills.
- Excellent attention to detail and commitment to coding accuracy.
- Strong written and verbal communication skills.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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Who are we
BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
