Certified Coding Specialist (Remote, Remote, US)
Job Description
Role - Certified Coding Specialist
Education & Certification (The below certifications support different type of coding needs, ie; inpatient coder required to have the CIC or the CCS, while an outpatient or professional coder would be expected to have a Certified Professional Coder (CPC) and/or a Certified Outpatient Coder (COC) designation.
Required: Certified Professional Coder (CPC) and/or Certified Outpatient Coder (COC)credentialed from the American Academy of Professional Coders (AAPC) obtained before hire or job transfer. All specialties accepted.
OR:
Required: Certified Coding Specialist (CCS) and/or Certified Inpatient Coder (CIC) credentialed from the American Health Information Management Association (AHIMA) obtained before hire or job transfer.
OR:
Certified Billing and Coding Certification from the National Health Career Association with a commitment to obtain one of the above within 6 months of job offer
Requirements:
§ Experience in E&M Specialty Coding- Outpatient, Inpatient, observation, Critical care facilities using ICD, Modifiers, CPT, HCPCS codes, applicable to role.
§ 0-5+ years of experience in E&M inpatient and/or outpatient medical record review, coding and reimbursement, preferred 3 years experience.
§ Must have strong knowledge of ICD-10 CM/PCS and CPT coding and prospective payment systems and proficiency with Microsoft Windows operating systems and Office applications, such as Word, Excel, PowerPoint
§ Able to work well with minimal supervision.
§ Able to communicate clearly both written and verbally.
§ Able to generate reports for management review that present results in a clear manner.
§ Able to meet deadlines and respond well to frequent changes n priorities.
§ Adept in handling changes in coding / billing regulation and requirements. .
§ Able to maintain positive and productive relationships with internal and external teams and customers.
§ Able to work independently and be a self-starter.
Roles & Responsibilities (Firstsource may assign a Certified Coding Specialist to one or more of the following roles based on their experience and client needs.)
Coding Denials: Claim is reviewed AFTER a denial has been received.
§ Review payer denials to identify coding-related issues (ICD-10-CM/PCS, CPT, HCPCS, modifiers, DRG/APC assignments)
§ Perform root cause analysis on denials related to medical necessity, bundling, edits, and documentation
§ Correct coding errors and rebill claims or recommend corrections to client in accordance with payer policies and regulatory guidelines
§ Collaborate with client teams (CDI (Clinical Documentation Improvement), providers, billing, and revenue integrity to resolve documentation and coding issues.
§ Submit appeals with appropriate clinical justification and coding support.
§ Track, trend, and report denial patterns and recommend process improvements.
§ Ensure compliance with official coding guidelines, NCCI edits, LCD/NCDs, and payer-specific rules.
§ Maintain productivity and quality standards for denial resolution.
§ Participate in audits, education, and feedback initiatives.
§ Support training for coders and clinical staff on denial prevention strategies.
§ Use Encoder, billing, and EMR systems to research and resolve accounts.
§ Maintain accurate documentation of actions taken on each denial.
Coding: Claim is reviewed / coded prior to submission to payer.
§ Review inpatient, outpatient, ED, and/or professional fee medical records to assign accurate ICD-10-CM/PCS, CPT, and HCPCS codes.
§ Apply official coding guidelines, payer rules, NCCI edits, and facility policies.
§ Ensure codes reflect complete, clear, and compliant documentation.
§ Abstract data elements required for billing, quality, and reporting.
§ Query providers when documentation is unclear, incomplete, or conflicting.
§ Meet established productivity and quality standards.
§ Participate in internal and external audits and implement feedback.
§ Maintain compliance with HIPAA and all regulatory requirements.
§ Stay current with coding updates, payer changes, and regulatory guidance.
§ Collaborate with CDI, billing, and revenue integrity teams.
§ Support education and process improvement initiatives.
§ Use encoder, EMR, and billing systems efficiently and accurately.
§ Maintain detailed and timely account documentation.
All Coding Roles
§ In conjunction with the Coding , Denial and RCM Leadership, contribute to the development of educational and training opportunities for staff.
§ Creates update tracker and responsible for updating the team on trends and changes.
§ Provides feedback & coaching on common error scenarios