Medical Coder

Medical Coder / Coding Specialist

Job Type: 8:30AM - 4:00PM (Mon-Fri)

Department: Medical Records / Health Information Management

Work Location: Cranston, RI

Pay: $36.17

Job Summary

We are seeking a detail-oriented and knowledgeable Medical Coder to review, evaluate, and analyze inpatient and outpatient medical records to ensure accurate diagnostic and procedural coding, complete medical record abstraction, and appropriate healthcare reimbursement. The ideal candidate will have a strong understanding of medical terminology, anatomy, physiology, pathology, ICD-10-CM, and CPT-4 coding systems, along with experience interpreting healthcare documentation and applying coding regulations.

The Medical Coder will collaborate with physicians, medical records personnel, billing staff, and other healthcare professionals to resolve documentation discrepancies, maintain accurate patient records, and support timely and compliant billing and reimbursement processes. This role requires a high level of accuracy, confidentiality, analytical ability, and knowledge of Medicare, Medicaid, and other third-party payer requirements.

Key Responsibilities

• Review and evaluate inpatient and outpatient medical records to extract accurate diagnostic, procedural, and demographic information.
• Assign appropriate diagnosis and procedure codes using applicable ICD-10-CM and CPT coding guidelines and regulations.
• Apply current coding standards and reimbursement requirements to support accurate and appropriate financial reimbursement.
• Ensure correct code selection, sequencing, and documentation of diagnoses and procedures.
• Identify incomplete, unclear, inconsistent, or questionable medical documentation and refer cases to the attending physician, Medical Records Director, or Medical Director for clarification and resolution.
• Provide coding guidance and technical assistance to physicians, medical records personnel, and billing staff.
• Collaborate with the billing department to maintain accurate data, support internal controls, and minimize coding and billing errors.
• Verify information documented on patient abstract forms, including applicable PSI abstract forms, and review supporting information for accuracy and completeness.
• Use computer systems and healthcare databases to verify patient coverage, insurance eligibility, and applicable reimbursement requirements.
• Ensure coded and abstracted medical records are completed and forwarded to the billing department in a timely manner.
• Maintain a weekly status log of admissions, transfers, and discharges to track medical records and ensure records are accounted for and completed.
• Abstract and enter accurate medical information into financial, statistical, and billing databases.
• Maintain strict confidentiality of patient health information and comply with applicable privacy policies and regulations, including HIPAA.
• Assist supervisors and medical staff with additional medical records, coding, documentation, and reimbursement-related duties as assigned.

Required Knowledge, Skills, and Abilities

• Extensive knowledge of medical terminology, anatomy, physiology, pathology, pharmacology, diagnostic testing, and medical procedures.
• Strong working knowledge of ICD-10-CM and CPT-4 coding classification systems and applicable coding guidelines.
• Understanding of Medicare, Medicaid, commercial insurance, and other third-party payer requirements.
• Knowledge of healthcare billing, reimbursement policies, and medical record documentation standards.
• Ability to accurately interpret clinical documentation and assign appropriate diagnosis and procedure codes.
• Ability to identify documentation deficiencies and communicate effectively with physicians and other healthcare professionals to obtain clarification.
• Strong analytical, organizational, problem-solving, and data abstraction skills.
• Proficiency in electronic medical records, coding software, and healthcare information systems.
• Excellent written and verbal communication skills and the ability to collaborate across clinical, medical records, and billing departments.
• Demonstrated commitment to accuracy, confidentiality, compliance, and timely completion of assigned work.

Education and Experience

Candidates should meet one of the following educational or professional qualification pathways:

• Graduation from an accredited college with a specialization in medical records science or health information management.
• Graduation from an approved nursing school, together with Certified Coding Specialist (CCS) certification through the American Health Information Management Association (AHIMA).
• Certified Professional Coder (CPC) certification through the American Academy of Professional Coders (AAPC), as applicable to the employer's requirements.
• An equivalent combination of education, professional certification, and relevant experience that demonstrates the required knowledge and competencies.

Experience

• Previous employment as a Medical Coder, Coding Abstractor, Coding Specialist, or in a comparable medical records coding position.
• Experience reviewing inpatient and outpatient medical records and applying CPT coding standards in a hospital reimbursement environment.
• Demonstrated ability to abstract medical information, support billing processes, and resolve coding or documentation discrepancies.

Preferred Qualifications

• Experience in an acute-care hospital or other approved inpatient/outpatient healthcare facility.
• Experience with medical record abstraction, coding audits, reimbursement review, and billing data validation.
• Familiarity with healthcare payer policies and electronic health record systems.
• Current professional coding certification, such as CCS or CPC.