Medical Coder Specialist

Ovii's Interpretation of the Role

The Medical Coder Specialist independently reviews and codes front‑end healthcare claims, ensuring accuracy and compliance with payer and regulatory guidelines. The role operates remotely within the United States and collaborates closely with revenue‑cycle partners to maintain high clean‑claim rates.

Role Snapshot

• Medical coding of front‑end claims
• Assign ICD‑10‑CM and CPT codes with modifiers
• Maintain ≥90% coding accuracy
• Resolve claim holds and rejections
• Collaborate with revenue‑cycle team
• Ensure HIPAA and payer compliance
• Complete required CEU credits

Must-Have Requirements

• Current AAPC or AHIMA certification
• Strong working knowledge of CPT and ICD‑10‑CM coding
• Medical terminology, anatomy and physiology knowledge
• Medicare reimbursement guidelines familiarity
• HIPAA compliance adherence
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook, Teams)
• Ability to research, analyze data and resolve coding issues
• Independent judgment in claim resolution
• Excellent written and verbal communication
• Minimum 3+ years professional coding experience
• Medical coding
• Front‑end claim processing
• HIPAA compliance
• AAPC Certification
• AHIMA Certification
• Must hold a current AAPC or AHIMA certification
• Minimum 3 years professional coding experience
• Must be authorized to work in United States (E‑Verify)

Nice-to-Have Signals

• Familiarity with proper English grammar and documentation standards

Work Setup

• Location: United States
• Work mode: REMOTE
• Remote scope: COUNTRY_RESTRICTED
• Remote countries: United States
• Employment type: Full-Time

Eligibility Gates

• Work authorization: Must be authorized to work in United States (E‑Verify)
• Visa sponsorship: no

Not Specified in JD

• Salary range
• Visa sponsorship
• Travel requirement
• Shift requirement
• Security clearance
• Background check
• Notice period

What You'll Likely Work On

• Review medical records and assign appropriate ICD‑10‑CM and CPT codes with modifiers for front‑end claims.
• Maintain at least 90% coding accuracy while resolving claim holds and preventing rejections.
• Apply payer guidelines, HIPAA regulations, and internal policies to verify medical necessity.
• Collaborate with revenue‑cycle partners and the Coding Team Lead to address coding issues and trends.
• Stay current on laws, regulations, and payer policies affecting coding practices.
• Participate in department, one‑on‑one, and mentorship meetings and escalate complex cases as needed.
• Complete continuing education units (CEUs) and other required training.

Good Fit If You Have

• Strong attention to detail and independent judgment in coding decisions.
• Ability to interpret medical documentation, policies, and regulations.
• Comfortable working remotely in a fast‑paced environment.
• Excellent written and verbal communication with clinicians and staff.