The Certified Professional Coder (CPC) is responsible for reviewing clinical documentation and accurately assigning diagnosis and procedure codes for healthcare providers across multiple client organizations. This role ensures coding compliance with federal regulations, payer requirements, and industry standards while supporting optimal reimbursement and minimizing claim denials.
The ideal candidate is detail-oriented, knowledgeable in medical coding guidelines, and experienced working with multiple specialties and provider groups in a fast-paced medical billing environment.
Key Responsibilities
Medical Coding
Review medical records, encounter notes, operative reports, and supporting documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes.
Ensure coding accuracy and compliance with payer-specific requirements, industry regulations, and coding guidelines.
Analyze provider documentation to determine appropriate code selection and level of service.
Identify documentation deficiencies and communicate with providers and clients to obtain necessary clarification.
Apply coding updates, modifiers, and regulatory changes as required.
Compliance & Quality Assurance
Maintain compliance with coding regulations, including CMS, Medicare, Medicaid, commercial payer, and industry standards.
Conduct coding audits and reviews to identify errors, trends, and opportunities for improvement.
Assist in the development and implementation of coding policies and procedures.
Monitor coding quality metrics and support corrective action initiatives when necessary.
Stay current on coding updates, reimbursement changes, and regulatory requirements.
Client Support
Support multiple healthcare clients across various specialties and practice settings.
Provide coding guidance and education to providers, practice staff, and internal teams.
Respond to coding-related inquiries and assist with claim resolution efforts.
Collaborate with credentialing, billing, accounts receivable, and client success teams to improve reimbursement outcomes.
Revenue Cycle Support
Review denied claims and identify coding-related issues affecting reimbursement.
Recommend coding corrections and resubmission strategies when appropriate.
Assist with payer audits, appeals, and documentation requests.
Work closely with billing teams to reduce coding-related denials and improve clean claim rates.
Reporting & Process Improvement
Maintain coding productivity and accuracy standards.
Generate coding reports and track key performance indicators.
Identify trends impacting reimbursement, compliance, and operational efficiency.
Participate in workflow improvement initiatives to enhance coding processes and client outcomes.
Qualifications
Required
Current Certified Professional Coder (CPC) certification through the American Academy of Professional Coders (AAPC).
Minimum of 2 years of professional medical coding experience.
Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
Experience coding for physician practices, outpatient services, or multi-specialty healthcare organizations.
Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies.
Ability to interpret medical documentation and apply coding guidelines accurately.
Proficiency with Electronic Health Records (EHRs), practice management systems, and billing software.
Strong analytical and problem-solving skills.
Excellent written and verbal communication abilities.
Preferred
Experience working in a medical billing company or revenue cycle management environment.
Multi-specialty coding experience.
Additional coding certifications such as CPC-I, CPMA, COC, CRC, or CCS.
Experience conducting coding audits and provider education.
Familiarity with payer audits, appeals, and compliance programs.
Skills & Competencies
Exceptional attention to detail and accuracy.
Strong understanding of healthcare reimbursement methodologies.
Ability to manage multiple client accounts and priorities simultaneously.
Critical thinking and analytical skills.
Effective communication and provider education abilities.
Commitment to confidentiality and HIPAA compliance.
Ability to work independently while contributing to a collaborative team environment.
Numbers & Facts
Location
WA
Skills
Accounts Receivableunmatched
Analysis Skillsunmatched
Auditingunmatched
Billingunmatched
Billing Softwareunmatched
Centers for Medicare and Medicaid Services (CMS)unmatched
Certified Coding Specialist (CCS)unmatched
Certified Professional Coder (CPC)unmatched
Clinical Study Publicationsunmatched
Code Reviewsunmatched
Communication Skillsunmatched
Corrective Actionunmatched
Current Procedural Terminology (CPT)unmatched
Customer Support/Serviceunmatched
Detail Orientedunmatched
Documentationunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Healthcareunmatched
Healthcare Common Procedure Coding System (HCPCS)unmatched
Healthcare Providersunmatched
Healthcare Reimbursementunmatched
ICD-10unmatched
Industry Standardsunmatched
Maintain Complianceunmatched
Medicaidunmatched
Medical Billingunmatched
Medical Codingunmatched
Medical Record Systemunmatched
Medical Recordsunmatched
Medicareunmatched
Multitaskingunmatched
Outpatient Careunmatched
Performance Analysisunmatched
Performance Metricsunmatched
Policy Implementationunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
Process Improvementunmatched
Quality Metricsunmatched
Quality Monitoringunmatched
Regulatory Complianceunmatched
Reimbursementunmatched
Reporting Skillsunmatched
Revenue Managementunmatched
Sales Managementunmatched
Team Playerunmatched
Training/Teachingunmatched
Trend Analysisunmatched
Writing Skillsunmatched
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