Health Insurance Coder jobs

Job Title: Medical Coder
Schedule: Monday – Friday, 8:00 AM – 4:30 PM EST
EMR: eClinicalWorks (eCW)
Credentials Required: CPC (AAPC)

Position Summary

The MedVA CPC – Coder/Auditor is responsible for performing detailed reviews of provider documentation, coding accuracy, and claim integrity to ensure compliance with CPT, ICD-10, and payer-specific guidelines. This role serves as a critical quality checkpoint within the revenue cycle, supporting accurate charge capture, denial prevention, and audit readiness.

The ideal candidate will bring strong experience in ENT & Allergy coding and billing, along with a deep understanding of documentation requirements, regulatory compliance, and audit standards.

Key Responsibilities

Coding & Documentation Review

• Review provider documentation to ensure accurate assignment of CPT, ICD-10, and modifiers
• Validate that documentation fully supports services billed prior to claim submission
• Identify coding discrepancies, undercoding, overcoding, or missing documentation elements
• Ensure proper linkage of ICD-10 diagnoses to CPT codes based on medical necessity

Claim Work Queue Review

• Perform pre-bill and/or post-bill audits from designated claim work queues
• Analyze claims for compliance with AMA CPT guidelines, ICD-10-CM standards, payer policies, and applicable federal and state healthcare regulations
• Ensure adherence to CMS guidelines, medical necessity requirements, and applicable billing compliance rules, including awareness of OIG Work Plan focus areas and False Claims Act risk considerations
• Flag and correct issues prior to submission or escalate as needed
• Assist in reducing denials and compliance risk through proactive claim review

Audit & Compliance

• Conduct structured chart audits to evaluate documentation completeness, coding accuracy, and regulatory compliance
• Document audit findings and track trends, risks, and opportunities for improvement
• Support internal compliance initiatives, audit preparedness, and risk mitigation strategies
• Maintain audit documentation in accordance with organizational audit protocols

Allergy Specialty Focus

• Apply advanced knowledge of Allergy CPT codes, including but not limited to:
• 95165 – Allergen immunotherapy preparation
• 95117 – Immunotherapy administration (2+ injections)
• 95004 – Percutaneous allergy testing
• Review high-risk and high-volume allergy services for accurate billing, documentation support, and payer compliance
• Ensure adherence to payer-specific policies for allergy testing, antigen preparation, and immunotherapy services

Education & Feedback

• Provide clear, actionable feedback based on audit findings
• All findings and audit results are initially reported to the Coding Manager
• Participate in provider and staff education as directed, once findings are validated and approved for escalation
• Identify trends and opportunities for provider documentation improvement
• Collaborate with Coding, Compliance, and RCM leadership on education and training initiatives

Qualifications

Required (Non-Negotiable)

• Certified Professional Coder (CPC) – AAPC required
• Minimum 3–5 years of medical coding experience
• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding guidelines
• Experience performing coding audits and documentation validation
• Familiarity with EMR systems (eCW preferred) and claim work queues

Preferred ( Nice to have but not required)

• Experience with Allergy, ENT, or multi-specialty coding
• Auditing credentials (e.g., CPMA preferred)
• Experience in coding QA, compliance, or audit-focused roles
• Strong understanding of payer policies, NCCI edits, and medical necessity requirements

Why Join Us

• Work U.S. Hours, Stay Remote – Enjoy a stable Monday–Friday, 8:00 AM – 4:30 PM EST schedule
• Specialize in High-Demand Coding Areas – Gain deep expertise in Allergy and ENT coding
• Make a Real Impact – Play a critical role in ensuring accurate billing, reducing denials, and supporting compliance
• Collaborative Team Environment – Work closely with Coding, Compliance, and RCM leadership
• Growth Opportunity – Develop your skills in auditing, compliance, and provider education
• Fully Remote – Work from anywhere with a reliable internet connection

Reporting Structure

• Reports to: Coding Manager