Certified Professional Coder

Job Summary

A Certified Professional Coder (CPC) will focus on conducting Level of Service audits, ensuring accurate coding of medical procedures and diagnoses, and maintaining compliance with federal, state, and payer-specific regulations. The ideal candidate will have a strong background in Workers' Compensation, fee schedule application, and medical documentation analysis.

Primary Duties & Responsibilities

• Perform Level of Service audits on medical bills to validate coding accuracy and appropriateness.
• Review and interpret complex medical documentation including office visits, consultations, surgeries, and hospital services.
• Apply CPT, ICD-10, and HCPCS coding standards to ensure proper billing and reimbursement.
• Ensure compliance with state-specific fee schedules, Workers' Compensation regulations, and payer guidelines.
• Identify and resolve discrepancies in coding and documentation.
• Respond to provider appeals and inquiries with clear, regulation-based explanations.
• Collaborate with internal teams including customer service, billing, and compliance to resolve coding issues.
• Maintain up-to-date knowledge of coding guidelines, regulatory changes, and industry best practices.
• Protect the confidentiality of patient and provider information.
• Participate in ongoing training and maintain active CPC certification and required CEUs.

Qualifications

• Experience with multi-state jurisdictional regulations.
• Understanding of Usual & Customary, PPO discounts, and non-fee schedule claims.
• Minimum 2 years of experience in medical coding, preferably in Workers' Compensation or medical bill review.
• Background in hospital billing guidelines for inpatient and outpatient services.
• Prior experience in level of service auditing or clinical documentation improvement (CDI).
• CPC (Certified Professional Coder) certification required; CCS or CPC-A considered with relevant experience.
• Strong knowledge of CPT, ICD-10, HCPCS, and medical terminology.
• Familiarity with CompIQ Solutions or similar bill review platforms preferred.
• Excellent analytical, communication, and problem-solving skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ethnicity, disability, marital status, or any other characteristic protected by law.

Genfinity as an Equal Opportunity Employer, believes in each person's potential, and we'll help you achieve yours.

All information will be kept confidential according to EEO guidelines.

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