Certified Medical Coding Specialist

Job Summary

To support Utilization Management operations, the full-time Certified Medical Coding Specialist will provide coding expertise, research coding guidelines, and ensure compliance across various health plan lines of business while working remotely.

Key responsibilities

• Research, analyze, and interpret HCPCS, CPT, and ICD-10 coding guidance to support accurate coding decisions
• Develop and maintain Prior Authorization code lists and coding reference materials for health plan implementations
• Perform quality reviews of coding deliverables to ensure accuracy, completeness, and adherence to established standards

Required qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or equivalent certification
• High school diploma or equivalent required; Associate's or Bachelor's degree in a related field preferred
• Minimum of 3 years of medical coding experience, including HCPCS, CPT, and ICD-10 coding
• Experience with health plans, utilization management, and prior authorization preferred
• Knowledge of Medicare, Medicaid, and Commercial coding methodologies preferred