Senior Medical Coding Specialist

Job Summary:

The Senior Medical Coding Specialist is responsible for reviewing and auditing medical coding accuracy, documentation compliance, and coding quality across multiple healthcare specialties. The role validates ICD-10-CM, CPT, HCPCS, and modifier assignments against provider documentation, identifies coding deficiencies, prepares quality reports, and provides feedback to improve coding accuracy and compliance. This role serves as a coding subject matter expert supporting revenue cycle operations by ensuring coding practices meet payer, regulatory, and compliance requirements.

Job Description:

• Perform quality assurance audits of coded medical encounters across multiple specialties, including urgent care, primary care, behavioral health, wound care, podiatry, palliative care, and mobile imaging.

• Review provider documentation to validate appropriate ICD-10-CM, CPT, HCPCS Level II codes, modifiers, and E/M coding guidelines.

• Identify coding errors, including under-coding, over-coding, unbundling, and missed charge opportunities.

• Evaluate documentation accuracy and ensure medical necessity, specificity, and compliance requirements are met.

• Prepare and distribute coding QA reports highlighting audit findings, trends, error rates, and improvement opportunities.

• Provide feedback and education to providers and coding teams to improve coding accuracy and documentation quality.

• Maintain compliance with CMS, AMA, AAPC/AHIMA, HIPAA, and payer-specific coding guidelines.

• Perform coding review, validation, and reporting activities using AthenaOne (athenahealth) EMR/practice management platform.

• Support continuous improvement initiatives related to coding workflows and revenue cycle performance.

Qualifications:

• Experience reviewing provider documentation and validating coding accuracy.

• Demonstrates strong understanding of appropriate medical charting and the link between documentation and code selection.

• Demonstrates strong knowledge of ICD-10-CM, CPT, HCPCS Level II, modifiers, E/M guidelines, and payer coding policies.

• Demonstrates strong attention to detail, sound analytical judgment, and the ability to work independently in a remote setting.

• Demonstrates strong analytical skills with ability to identify trends, errors, and improvement opportunities.

• Clear and coherent both written and verbal communication skills in English.

Screening Criteria:

• Active medical coding certification such as CPC (AAPC) or CCS (AHIMA).

• Minimum of five (5) years of medical coding experience.

• Experience in coding across multiple specialties, including several of the service lines listed above (Urgent Care, Podiatry, Wound Care/Advanced Wound Care, Primary Care, Palliative Care, Behavioral Health, and Mobile Imaging).

• Experience using AthenaOne (athenahealth) or similar EMR/practice management systems.

• Must have stable employment history.