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Medical Coder
Innovaccer. Independently review, analyze, and resolve assigned front-end scrubs, claim holds, and denied claims .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical coding, including proficiency in CPT and ICD-10-CM coding, while ensuring compliance with HIPAA regulations and maintaining high coding accuracy. Strong analytical skills are essential for resolving claims issues and preparing accurate documentation.
Highest-signal resume keywords
AAPC Or AHIMA Coding CertificationCPT CodingICD-10-CM CodingMedical TerminologyHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Coding AccuracyClaims ResolutionFront-End Coding ReviewAppeal Letter CreationMedical Record ReviewData AnalysisPolicy InterpretationClinical Terminology InterpretationInsurance Guidelines FamiliarityEOB Review
Soft Skills
Excellent Written CommunicationExcellent Verbal CommunicationIndependent JudgmentCollaborative Working RelationshipsConfidentiality Commitment
Tools & Technologies
Microsoft Office SuiteWordExcelOutlookTeams
Certifications & Qualifications
AAPC Coding CertificationAHIMA Coding Certification
Industry Keywords
Medical BillingMedicare Reimbursement GuidelinesCoding ErrorsClaim HoldsDenied ClaimsMedical Necessity GuidelinesCEU RequirementsPayer PoliciesClinical DocumentationAnatomy And Physiology
About the role
Key responsibilities & impact- Independently review, analyze, and resolve assigned front-end scrubs, claim holds, and denied claims
- Average 10 front-end holds/denials per hour
- Review coding and resubmit corrected claims to insurance
- Create appeal letters/forms with medical documentation
- Maintain a minimum of 92% coding accuracy
- Assign ICD-10-CM and CPT codes with appropriate modifiers for professional fee services
- Review medical records and documentation to determine appropriate codes for services and diagnoses
- Ensure diagnosis codes meet local and national medical necessity guidelines
- Use internal coding resources, payer guidelines, and reference materials for accurate and compliant coding
- Follow HIPAA regulations and protect privacy and confidentiality
- Maintain current knowledge of laws, regulations, payer policies, and industry guidance
- Participate in department, one-on-one, and mentorship meetings with the Coding Team Lead
- Escalate client trends and coding-related questions to the Coding Manager
- Maintain and complete all CEU requirements
- Perform other assigned duties
Requirements
What you’ll need- Must hold a current AAPC or AHIMA Coding Certification for a minimum of 3 years
- Minimum of 3+ years of professional coding experience
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines
- Prior experience reviewing front-end coding errors before submitting to insurance
- Prior experience reviewing and correcting coding from insurance denials
- Prior experience submitting corrected claims and appeals
- Prior experience with insurance guidelines and EOBs
- Familiarity with proper English grammar, usage, and professional documentation standards
- Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues
- Ability to read, interpret, and apply policies, procedures, laws, and regulations
- Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures
- Demonstrated ability to exercise independent judgment in coding and claim resolution
- Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff
- Strong commitment to maintaining confidentiality and safeguarding protected health information
- Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements
- Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams)
Benefits
Comp & perks- 20 days of fixed time off per year, in addition to company holidays
- Best-in-class parental leave
- Monetary incentives and company-wide recognition
- Medical, dental, and vision insurance
- 100% company-paid short- and long-term disability insurance
- 100% company-paid basic life insurance
- Discounted legal aid
- Pet insurance