Innovaccer Analytics
Healthcare
MedicalCodingSpecialist
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Medical Coding Specialist at Innovaccer Analytics. Skills: Medical coding, Claim resolution, HIPAA compliance. Review assigned front-end claims. Analyze assigned front-end claims”
What You'll Achieve.
Maintain 90% coding accuracy; Resolve all assigned front-end claim holds
Industry & Context.
Research data; Analyze data; Draw logical conclusions; Resolve coding issues; Resolve documentation issues
What They're Looking For.
Must Have
Current AAPC or AHIMA Certification, 3+ years of professional coding experience, Working knowledge of CPT, ICD-10-CM, Working knowledge of medical terminology, Working knowledge of anatomy and physiology, Working knowledge of state and federal Medicare reimbursement guidelines, Familiarity with proper English grammar, Familiarity with usage and professional documentation standards, Ability to research and analyze data, Ability to draw logical conclusions, Ability to resolve coding or documentation issues, Ability to read, interpret, and apply policies, procedures, laws, and regulations, Ability to accurately read and interpret medical documentation, Ability to accurately read and interpret clinical terminology, Ability to accurately read and interpret documented procedures, Demonstrated ability to exercise independent judgment in coding and claim resolution, Commitment to maintaining confidentiality, Commitment to safeguarding protected health information, Prior experience working in a medical billing environment, Strict adherence to HIPAA compliance requirements, Demonstrated proficiency in Microsoft Office Suite, Minimum of 3 years certification
Nice to Have
Experience with ICD-10-CM, Experience with CPT, Experience with medical terminology, Experience with anatomy and physiology, Experience with state and federal Medicare reimbursement guidelines
What You'll Do.
Review assigned front-end claims
Analyze assigned front-end claims
Resolve assigned front-end claims
Ensure accurate claim submission
Ensure timely claim submission
Identify coding-related issues
Correct coding-related issues
Apply established coding guidelines
Apply payer requirements
Apply organizational policies
Prevent claim rejections
Support clean claim rates
Promote efficient reimbursement processes
Assign ICD-10-CM codes
Assign appropriate modifiers
Review medical records
Review applicable documentation
Determine appropriate codes for documented services
Determine appropriate codes for documented diagnoses
Ensure diagnosis codes meet medical necessity guidelines
Utilize internal coding resources
Utilize payer guidelines
Utilize reference materials
Ensure accurate coding
Ensure compliant coding
Follow HIPAA regulations
Uphold standards of privacy
Uphold standards of confidentiality
Maintain current knowledge of laws
Maintain current knowledge of regulations
Maintain current knowledge of payer policies
Maintain current knowledge of industry guidance
Independently review claim holds
Independently resolve claim holds
Participate in department meetings
Participate in one-on-one meetings
Participate in mentorship meetings
Escalate identified client trends
Escalate coding-related questions
Maintain CEU requirements
Perform other duties or tasks as assigned
How You'll Work.
Team & Collaboration
Revenue cycle partners; Coding Team Lead
Communication Scope
Written communication; Verbal communication; Prepare reports; Clarify documentation needs; Maintain collaborative working relationships
Full Job Description
**About the Role** The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. **A Day in the Life** · Averages 10 front-end holds per hour · Maintains a minimum of 90% coding accuracy. · Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment. · Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses. · Ensures all diagnosis codes meet local and national medical necessity guidelines. · Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services. · Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality. · Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices. · Independently reviews and resolves all assigned front-end claim holds. · Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead. · Escalates identified client trends to the assigned Coding Team Lead. · Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification. · Maintains and completes all CEU requirements. · Performs other duties or tasks as assigned. **Pay Range : $24-$28/HR
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