Healthcare Claims Management

Compensation

Full Description

About Us Healthcare Chaos Management (HCM) is a 40-year-old, nationally scaled healthcare revenue cycle company that is transforming into a cutting-edge Healthcare FinTech organization. We serve hospitals and healthcare systems across the U.S., blending human-centric service with intelligent automation to improve patient financial experiences and optimize healthcare revenue operations. Job Overview The Certified Coder is responsible for accurately reviewing, analyzing, and assigning medical codes for diagnoses, procedures, and services to ensure proper billing and reimbursement within HCM’s revenue cycle operations. This position supports both compliance and financial performance by ensuring coding accuracy in accordance with payer guidelines, state and federal regulations, and HCM policies. The Certified Coder collaborates with revenue cycle specialists and account managers to ensure complete and compliant documentation, resolve coding discrepancies, and enhance the overall integrity of the claims process. This is a remote position requiring a high level of independence, attention to detail, and adherence to HCM’s quality and productivity standards. Key Performance Indicators (KPIs) • Coding Accuracy – Maintain 95% or higher accuracy rate in all coding audits and reviews. • Productivity – Meet or exceed daily and monthly productivity standards for coded encounters. • Compliance – Ensure 100% adherence to HIPAA, CMS, and payer-specific regulations. • Denial Reduction – Contribute to measurable decreases in claim denials related to coding errors. • Documentation Quality – Collaborate with providers to ensure accurate and complete clinical documentation supporting assigned codes. Key Responsibilities 1. Coding & Documentation Review • Review and analyze medical records to assign appropriate ICD-10, CPT, and HCPCS codes for diagnoses, procedures, and services. • Ensure coding accuracy for inpatient, outpatient, and professional services according to current guidelines and payer rules. • Validate documentation to ensure it meets regulatory, compliance, and audit requirements. • Identify incomplete or unclear documentation and work with relevant teams to resolve discrepancies. 2. Compliance & Audit Readiness • Maintain compliance with CMS, OIG, and payer regulations as well as internal HCM coding policies. • Participate in internal and external coding audits, implementing corrective actions as needed. • Remain current on updates to coding regulations, payer rules, and documentation standards. • Protect patient confidentiality and comply with HIPAA at all times. 3. Revenue Cycle Collaboration • Partner with revenue cycle specialists and account managers to ensure proper claim submission and reduce rework. • Communicate coding-related issues impacting claims processing or reimbursement to the Client Excellence Manager. • Assist with denial analysis and contribute to appeal documentation where coding is a contributing factor. • Support eligibility and enrollment teams when documentation or payer requirements intersect with coverage validation. 4. Quality Assurance & Continuous Improvement • Monitor personal productivity and accuracy through ongoing self-audits and peer feedback. • Recommend process improvements to enhance efficiency and coding quality. • Participate in ongoing training sessions and professional development activities to maintain certification and expand knowledge. Qualifications & Experience • Current certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Coding Specialist–Physician-based (CCS-P) required. • Minimum 3 years of medical coding experience, preferably in a healthcare revenue cycle or hospital setting. • Strong understanding of ICD-10, CPT, and HCPCS coding systems and related payer rules. • Knowledge of medical terminology, anatomy, and healthcare billing processes. • Experience with electronic health records (EHR) and practice management systems. • Strong analytical and problem-solving skills with attention to accuracy and detail. • Excellent written and verbal communication skills for working across departments and clients. • Ability to work independently in a remote environment, managing workload and meeting deadlines consistently. • Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred. Work Environment This is a remote position. The employee will work primarily from a home office environment, requiring reliable internet access and the ability to maintain confidentiality in all communications. Occasional virtual meetings with internal teams and clients may be required. Physical Demands While performing the duties of this job, the employee is regularly required to sit for extended periods, use hands to operate computer equipment, and communicate via phone or video. The employee must occasionally lift up to 10 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions. Job Type: Full-time Pay: From $18.00 per hour Expected hours: 40 per week Benefits: • 401(k) • 401(k) matching • Dental insurance • Employee assistance program • Flexible schedule • Flexible spending account • Health insurance • Health savings account • Life insurance • Paid time off • Vision insurance Application Question(s): • Please indicate your compensation needs for this role? • How many years of experience do you have in medical coding? • Do you have a current certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Coding Specialist–Physician-based (CCS-P)? Work Location: Remote