[Hiring] RCM Coder @SENTA Partners

Role Description

The Professional Coder is responsible for reviewing clinical documentation and accurately assigning CPT, HCPCS, ICD-10-CM, and applicable modifier codes for professional medical services. This role ensures compliance with established coding guidelines, CMS regulations, NCCI edits, payer policies, and organizational standards to support accurate reimbursement, clean claims, and regulatory compliance. The Professional Coder collaborates closely with providers, clinical staff, revenue cycle teams, and coding leadership to identify documentation and coding opportunities, resolve discrepancies, reduce denials, and promote revenue integrity. The ideal candidate possesses strong knowledge of professional-fee coding, medical terminology, payer requirements, and reimbursement methodologies, with experience in ENT and surgical coding preferred.

Key Responsibilities

• Review physician and advanced practice provider documentation to determine the appropriate diagnosis and procedure codes.
• Assign accurate CPT, HCPCS, ICD-10-CM, and modifier codes based on documentation and applicable billing and coding guidelines.
• Apply appropriate evaluation and management (E/M) coding principles, including medical decision-making and time when applicable.
• Review surgical, procedural, office, diagnostic, allergy and ENT documentation for coding accuracy.
• Identify and appropriately report separately identifiable services, bundled services, add-on codes, bilateral procedures, multiple procedures, and modifier requirements.
• Review claims for NCCI edits, Medically Unlikely Edits (MUEs), medically necessary units, payer-specific billing rules, and other claim-editing issues.
• Research payer policies, Medicare Administrative Contractor (MAC) requirements, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and other applicable reimbursement policies.
• Identify documentation deficiencies and communicate professionally with providers regarding coding clarification and documentation requirements.
• Prepare and submit compliant coding queries when documentation does not support accurate code assignment.
• Assist with claim denials, appeals, billing or coding corrections, and payer inquiries.
• Monitor changes to CPT, HCPCS, ICD-10-CM, CMS, and commercial payer coding and reimbursement requirements.
• Maintain current knowledge of specialty-specific coding guidelines and payer policies.
• Participate in coding audits and quality assurance activities.
• Identify trends in denials, underpayments, overpayments, billing and coding errors, and communicate findings to coding and revenue cycle leadership.
• Maintain required coding productivity and accuracy standards.
• Protect patient confidentiality and comply with HIPAA and organizational privacy policies.
• Escalate complex or ambiguous coding issues to the appropriate coding leadership or compliance resource.

Qualifications

• High school diploma or equivalent required.
• Professional coding certification such as CPC or CCS.
• Minimum of 2 years of professional medical coding experience.
• Working knowledge of CPT, HCPCS, ICD-10-CM, NCCI edits, MUEs, and Medicare coding requirements.
• Knowledge of professional fee coding and physician practice billing.
• Strong understanding of medical terminology, anatomy, and clinical documentation.
• Ability to interpret complex medical records and determine appropriate code assignment.
• Strong attention to detail and analytical skills.
• Ability to research and interpret payer and regulatory requirements.
• Excellent written and verbal communication skills.
• Ability to work independently while meeting established productivity and accuracy standards.
• Primarily computer-based work in remote environment.
• Ability to remain focused for extended periods while reviewing electronic medical records.
• Frequent use of computer systems, coding resources, and payer portals.
• Required to meet established productivity and turnaround-time expectations.
• Required to meet established quality standards.
• Experience coding for ENT (clinic and surgery) and allergy specialties.

Benefits

• Comprehensive Health Benefits (Medical, Dental, and Vision)
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• Holidays & Paid Time Off (PTO)
• Employee Assistance Program (EAP)
• Retirement Contribution Program - 401(K) Match