JOB TITLE: Medical Coding Specialist and Educator

FLSA: Non-Exempt

REPORTS TO: Billing Office Manager

COMPENSATION:

• Hourly Range: $21.00 - $30.00 (based on experience)
• Medical benefits including vision and dental (dependent upon job status)
• 401k profit sharing plan eligible after one year and 1,000 hours
• Paid holiday, vacation, and personal leave

ENVIRONMENT: Outpatient, clinical care setting.

GENERAL SUMMARY OF DUTIES: The Medical Coding Specialist and Educator is responsible for accurate and compliant professional fee coding while supporting the organization’s revenue cycle through A/R follow-up, coding and billing research, provider and staff education, and resolution of coding, documentation, and payer-related issues. This position serves as a subject matter resource for providers, clinical staff, and billing personnel and works collaboratively with leadership to identify trends, improve processes, increase reimbursement accuracy, and promote compliance with coding, billing, documentation, and payer requirements. 

DUTIES PERFORMED

Professional Fee Coding

• Perform accurate and timely professional fee coding using ICD-10-CM, CPT, HCPCS, modifiers, and applicable outpatient coding guidelines.
• Review medical records, provider documentation, charges, and related information to ensure services are appropriately coded and supported.
• Identify incomplete, unclear, or conflicting documentation and communicate with providers regarding clarification needs.
• Research and resolve coding questions, edits, billing issues, and documentation concerns.
• Maintain current knowledge of coding guidelines, payer requirements, regulatory changes, and organizational policies.

A/R & Revenue Cycle Support

• Work assigned accounts receivable and assist with identifying and resolving unpaid or underpaid claims.
• Research claim denials, payer requirements, coding issues, and reimbursement discrepancies.
• Assist with appeals and other payer follow-up activities as needed.
• Identify recurring A/R, denial, coding, or documentation trends and communicate opportunities for improvement to management.
• Collaborate with billing staff and management to resolve issues affecting timely and accurate reimbursement.

Education & Provider/Staff Support

• Develop and provide education to providers, clinical staff, billing staff, and other personnel regarding coding, documentation, billing, compliance, and payer requirements.
• Develop and maintain educational materials, reference guides, tip sheets, presentations, and other resources.
• Provide individual and group education based on identified coding, documentation, billing, or compliance needs.
• Assist with onboarding and ongoing education related to coding and revenue cycle processes.
• Communicate changes in coding guidelines, payer requirements, regulatory requirements, and organizational procedures.
• Serve as a resource to providers and staff for coding, documentation, billing, and reimbursement questions.

Research, Compliance & Process Improvement

• Research coding, billing, documentation, payer, and regulatory questions and provide recommendations to management and staff.
• Identify trends and recurring issues that may affect coding accuracy, documentation quality, compliance, or reimbursement.
• Assist with reviewing and updating coding and billing procedures, workflows, and educational resources.
• Support compliance with applicable coding, billing, payer, and regulatory requirements.
• Participate in coding audit preparation, quality assurance activities, or other audit-related projects as assigned.
• Maintain confidentiality of patient, financial, coding, and organizational information.
• Maintain professional coding certification and participate in continuing education to remain current in the field.
• Perform other duties as assigned.

PERFORMANCE REQUIREMENTS:

• Strong working knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and outpatient professional fee coding.
• Knowledge of medical billing, A/R, denials, appeals, reimbursement, and third-party payer requirements.
• Knowledge of coding, billing, documentation, and regulatory compliance requirements.
• Ability to accurately interpret medical documentation and apply coding guidelines.
• Ability to research and resolve coding, billing, A/R, and payer-related issues.
• Strong communication skills and the ability to effectively explain coding and billing concepts to providers, clinical staff, and billing personnel.
• Ability to develop and deliver effective educational materials and presentations.
• Strong analytical, organizational, and problem-solving skills.
• Ability to identify trends and recommend process improvements.
• Ability to work independently, prioritize multiple responsibilities, and meet deadlines.
• Proficiency with electronic medical records, practice management systems, Microsoft Office, and other applicable computer systems.
• Ability to adapt to changes in coding guidelines, payer requirements, technology, and organizational processes.
• Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts.

EDUCATION AND EXPERIENCE:

• High school diploma or equivalent required; associate degree in Health Information Management, Medical Coding, Health Information Technology, Business, or a related field preferred.
• Active CPC, CCS, CCS-P, or comparable nationally recognized professional coding certification required.
• Minimum of two years of professional fee coding experience in an outpatient, physician practice, or comparable healthcare setting preferred.
• Demonstrated experience with ICD-10-CM, CPT, HCPCS, modifiers, and outpatient coding guidelines.
• Experience with medical billing, A/R, denials, appeals, or revenue cycle processes preferred.
• Experience providing coding, documentation, billing, or compliance education to providers or staff preferred.
• Experience researching coding, billing, documentation, payer, or regulatory questions preferred.
• Experience with electronic medical record and practice management systems required.

PHYSICAL REQUIREMENTS: Work may require sitting for long periods of time; must be able to remain in a stationary position 75% of the time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, type at 40 wpm, operate a telephone, copier, fax machine, and such other office equipment, as necessary. It is necessary to view and type on computer screens for long periods and to work in environment which can be stressful. Ability to understand and effectively work in Microsoft Outlook, practice management systems, and electronic medical record system.  

TYPICAL WORKING CONDITIONS: Work is performed in an office environment. Involves frequent contact with patients in the office and via phone. Work may be stressful at times. Interaction with others is constant and interruptive. Contact involves dealing with sick people.

DISCLAIMER: The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.