Medical Billing and Coding

• Review home health and hospice clinical documentation across SOC, ROC, Recertification, Transfer, Discharge, and Admission time points
• Assign accurate ICD-10-CM diagnosis codes
• Sequence diagnoses according to ICD-10-CM guidelines, CMS requirements, PDGM payment methodologies, and hospice coding expectations
• Audit clinical charts for documentation gaps or inconsistencies
• Collaborate with clinical leadership and compliance teams to resolve query needs
• Meet productivity and turnaround-time goals to support billing and claim submissions
• Assist with internal quality assurance and external medical reviews, including TPE, ADRs, and compliance audits
• Collaborate with clinical, QA, compliance, and revenue cycle teams to improve documentation integrity and regulatory readiness
• Maintain current knowledge of CMS guidance, Medicare regulations, LCDs, and payer-specific updates
• Protect PHI and ensure HIPAA compliance
• Generate and maintain tracking logs, status updates, and coding reports for management

ICD-10 Coding Specialist, Home Health & Hospice

• Perform essential job functions of a certified coder
• Serve as an expert coder within a designated coding service line
• Perform peer audits and routine peer reviews according to documented standards
• Mentor and train new and existing coding staff
• Support management initiatives and assist with leadership activities in the coordinator/supervisor's absence
• Collaborate with supervisors, managers, staff, enterprise teams, and external entities on meetings and initiatives
• Assist employees with work-related matters
• Conduct regular staff rounding and complete reports for meetings
• Assist with annual budget preparation and adherence
• Interpret and analyze financial data to monitor performance and establish department benchmarks
• Act as a resource and mentor to others
• Create, update, and maintain department policies and procedures

HIM Cert Coder, Interventional Radiology, CPT, ICD-10

• Perform abstraction and in-depth analysis of medical documentation
• Assign appropriate procedural terminology and medical codes, including ICD-10, CPT-4, HCPCS, and DRG
• Analyze, enter, and manipulate databases
• Respond to and clarify internal requests for medical information
• Review codes created by electronic charge capture and assign codes through medical record documentation
• Review and resolve coding denials
• Resolve claims errors related to improper coding and provide feedback for correction and follow-up
• Abstract data and review codes for accuracy
• Perform system edit checks and correct errors
• Respond to coding information requests
• Communicate documentation improvement opportunities and coding issues to providers, departments, and designated leaders
• Consult internal customers and external vendors to clarify inconsistent or incomplete documentation
• Perform other duties as assigned

Medical Records Coder III

• Provide CPT, HCPCS, and ICD-10-CM coding across 1–4 specialties
• Perform professional fee, facility, or HCC coding
• Provide coding services supporting clients
• Calculate ProFee and/or Facility E/M levels using the company algorithm
• Recognize critical care cases based on patient acuity
• Code ER surgical procedures to capture additional revenue when appropriate
• Apply ICD-10-CM diagnosis codes to the highest available specificity
• Apply ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS diagnosis and procedure codes
• Interpret coding guidelines for accurate code assignment
• Assess documentation importance and reimbursement impact
• Follow AHIMA ethical coding standards and the company ethics and compliance program
• Comply with internal policies and procedures
• Participate in company-provided training and education
• Protect confidential company information and Personal Health Information
• Perform other duties assigned by leadership

Inpatient Coding Specialist

• Prepare billing data for payer billing
• Comply with contractual provisions for billing and encounter data submissions, including monthly reports
• Submit invoices to agencies
• Apply payments
• Collect on unpaid claims
• Prepare advance reconciliations and apply payments to the general ledger
• Enter information into computer databases for effective record keeping
• Collaborate with staff members to optimize service delivery
• Ensure compliance standards are met for audit purposes
• Maintain confidentiality of client records
• Identify process improvement opportunities
• Uphold company values and mission
• Perform other duties as assigned

Medical Billing, Claims Specialist

• Prepare billing data for payer billing
• Comply with contractual provisions for submission of billing and encounter data, including monthly reports
• Submit invoices to agencies
• Apply payments
• Collect on unpaid claims
• Prepare advance reconciliations and apply payments to the general ledger
• Enter information into computer databases for effective record keeping
• Collaborate with staff members to optimize service delivery
• Ensure compliance standards are met for audit purposes
• Maintain confidentiality of client records
• Identify opportunities to improve processes
• Uphold company values and mission
• Perform other duties as assigned

• Perform quality hospital coding on inpatient accounts, including Medicare/Non-Medicare, surgical, medical, cardiac, moms/babies, and trauma cases
• Maintain working knowledge of ICD-10 PCS, governmental regulations, official coding guidelines, and third-party documentation and billing requirements
• Code all services documented in patient charts with appropriate ICD-10/PCS codes
• Seek proper documentation when services or diagnoses are not documented appropriately
• Achieve and maintain 96% coding accuracy while maintaining high productivity
• Maintain an average productivity standard of 1 inpatient chart per hour final coded, subject to client and management requirements
• Follow facility-specific policies and procedures
• Work pending queues daily
• Follow facility query policy and CDI reconciliation process
• Correct and communicate charts requiring rebills to the facility daily
• Report coder downtime immediately to administrative staff
• Provide accurate answers to physician and hospital coding or billing questions within eight hours of request

HIM Inpatient Coder – Hospital

• Code inpatient professional services and nursing home professional services using CPT, ICD-10-CM, and HCPCS
• Code surgical cases using global surgical package rules and required add-on codes
• Assign E/M categories and levels for inpatient and consult services according to current E/M guidelines
• Apply NCCI bundling edits and assign modifiers, including 24, 25, 26, 51, 57, 59, and 79
• Apply VHA rules for billing supervising practitioners and residents under VHA Directives 1400.01 and 1401
• Apply teaching physician documentation requirements
• Review documentation in CPRS
• Update provider names in PCE or the surgery package as needed
• Enter codes in VistA through the VA-approved encoder
• Flag records with missing, unsigned, or insufficient documentation
• Re-review coded records when the VA questions them before billing or after a claim is denied
• Maintain at least 95% accuracy and meet each facility's turnaround times
• Support Veterans Affairs medical centers in VISN 7, primarily Atlanta and Birmingham facilities

Medical Coder, Professional Fee Coder – Inpatient

• Code outpatient encounters, including clinic visits, urgent care, radiology, lab, ancillary services, and outpatient surgery
• Use ICD-10-CM, CPT-4, and HCPCS Level II
• Assign E/M levels according to current E/M guidelines, CPT Assistant, and Coding Clinic
• Apply NCCI bundling edits and add appropriate modifiers, including 25, 59, and 91
• Check whether multiple CPT codes are components of a larger procedure
• Assign ICD-10 diagnoses to ancillary or diagnostic tests based on medical necessity
• Review documentation in CPRS and enter codes and data into the VistA Patient Care Encounter (PCE) package through the VA-approved encoder
• Determine whether encounters are billable
• Flag duplicate encounters, encounters created in error, and records that do not support assigned codes
• Re-review coded records when questioned by the VA before billing or after claim denial
• Maintain at least 95% accuracy and meet each facility's turnaround times
• Support Veterans Affairs medical centers in VISN 7 across Georgia, Alabama, and South Carolina

Medical Coder, Outpatient

• Run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina
• Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance
• Review up to the first 25 diagnoses and first 25 procedures on each record for facility and professional services
• Help build statistically valid samples using a 95% confidence level and at least 10% of records
• Develop data collection tools for each audit
• Review each facility's HIMS policies and coding procedures before audits
• Classify coding, diagnosis, modifier, documentation, and compliance errors, supporting each with coding references
• Write facility audit reports covering accuracy, financial impact, and areas of concern
• Contribute to a network-wide report
• Review draft findings with the HIMS Chief, COR, and facility leaders within 7 business days of the audit
• Deliver final reports within 15 business days
• Create facility-specific training plans
• Lead at least 2-hour train-the-trainer education sessions using real charts for coding staff, managers, and physicians
• Conduct exit conferences with Health Information Management leadership
• Travel to VA facilities only when authorized by the government

Medical Billing and Coding jobs in United States

ICD-10 Coding Specialist, Home Health & Hospice

HIM Cert Coder, Interventional Radiology, CPT, ICD-10

Medical Records Coder III

Inpatient Coding Specialist

Medical Billing, Claims Specialist

Medical Billing, Claims Specialist

HIM Inpatient Coder – Hospital

Medical Coder, Professional Fee Coder – Inpatient

Medical Coder, Outpatient

Medical Coding Auditor / Coding Validation Reviewer