The Medical Coding Specialist provides coding expertise to support Utilization Management operations, health plan implementations, prior authorization program development, and clinical policy initiatives. This position is responsible for researching, analyzing, and interpreting HCPCS, CPT, and ICD-10 coding guidance to support accurate prior authorization requirements, coding resources, and client deliverables across Medicare, Medicaid, Commercial, and Marketplace lines of business.The Medical Coding Specialist partners with clinical, operational, compliance, business development, and client teams to ensure coding recommendations are accurate, compliant, and operationally sound. Success in this role requires strong attention to detail, critical thinking, organization, and the ability to produce high quality work while managing multiple priorities.
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIESThe Medical Coding Specialist's responsibilities include, but are not limited to:
Coding Support• Research, analyze, and interpret HCPCS Level II, CPT, ICD-10-CM, and related coding guidance.• Review coding resources, CMS guidance, payer policies, and regulatory requirements to support coding decisions.• Assist with determining prior authorization requirements and appropriate code categorization.• Apply coding knowledge across Medicare, Medicaid, Commercial, and Marketplace products.
Prior Authorization Program Support• Develop, validate, and maintain Prior Authorization code lists and coding reference materials.• Support implementation of new health plans, benefit designs, and coding configurations.• Review client specific coding requirements and ensure recommendations align with contractual and regulatory requirements.• Identify opportunities to improve coding consistency and operational efficiency.
Quality Review• Perform thorough self review of work prior to submission to ensure accuracy, completeness, and consistency.• Validate coding deliverables for duplicate records, formatting, categorization, and completeness.• Maintain accurate documentation supporting coding decisions and recommendations.• Meet established quality standards and project deadlines.
Research and Problem Solving• Research unfamiliar coding scenarios using available coding resources and regulatory guidance.• Identify questions or areas requiring clarification early in the work process.• Present questions with supporting research and a recommended approach when seeking guidance.• Participate in discussion and resolution of coding issues with internal stakeholders.
Collaboration• Serve as a coding resource for Medical Management and other internal departments.• Partner with clinical, operational, provider relations, credentialing, compliance, and business development teams on coding related initiatives.• Support client implementations, operational projects, and coding validation activities.• Participate in internal and external meetings as needed.
Education and Continuous Improvement• Maintain current knowledge of coding regulations, CMS guidance, and industry best practices.• Assist with development of coding guidance documents, training materials, and internal reference tools.• Participate in audits, quality improvement initiatives, and accreditation activities.• Perform other duties as assigned.
EDUCATION:• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or equivalent coding certification required/accepted.• High school diploma or equivalent required.• Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferred.
EXPERIENCE:• Minimum of 3 years of medical coding experience.• Experience with HCPCS, CPT, and ICD-10 coding required.• Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer operations preferred.• Knowledge of Medicare, Medicaid, and Commercial coding methodologies preferred.• Experience reviewing CMS guidance, payer policies
SALARY: 65,000/Annually
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
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