Role Overview
The Senior Medical Coding Specialist is responsible for analyzing high-dollar, complex claims by applying advanced coding knowledge, research, and regulatory standards to ensure accurate billing practices. This role plays a critical part in identifying billing discrepancies, ensuring compliance, and supporting both domestic and global coding operations.
What You Will Do
Review and analyze complex inpatient, outpatient, and practitioner claims for medical appropriateness and billing accuracy, apply national and international coding standards to ensure compliance and accuracy, and support daily operations and departmental processes.
Why It Might Be a Fit
This role requires strong expertise in Workers’ Compensation claims, as well as the ability to apply both U.S. and international coding standards in a fast-paced, high-impact environment. The ideal candidate will have a strong understanding of payer reimbursement policies, medical necessity criteria, and regulatory standards.
Requirements
- Minimum of 2+ years of Workers’ Compensation coding experience
- Current coding certification (AHIMA or AAPC) or active medical license (RN, MD)
- 7+ years of experience in a clinically related field
- Extensive knowledge of inpatient and outpatient billing, including UB-04, revenue codes, CPT, HCPCS, ICD-10, DRG, and APCs
- Familiarity with international coding systems (e.g., ICD-10-AM, OPCS-4, SNOMED CT, CCI) preferred
- Strong analytical, problem-solving, and decision-making skills
- Excellent communication skills, including the ability to explain complex coding concepts clearly
- Ability to develop training materials and support knowledge sharing across teams
- Ability to manage multiple priorities in a fast-paced environment
- Strong attention to detail and ability to work independently
Benefits
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year
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