Medical Coder (Hybrid)

GENERAL SUMMARY OF DUTIES: Provides coding, audit, and compliance support for all clinical services rendered by the organization. This role ensures accurate code assignment, adherence to FQHC billing and reimbursement regulations, and supports risk mitigation efforts through provider education and ongoing audit activities.

SUPERVISION EXERCISED: None

ESSENTIAL FUNCTIONS:

• Conduct routine and targeted provider coding audits to ensure compliance with FQHC billing requirements, Medicare, Medicaid, and commercial payer policies.
• Analyze audit findings and communicate results to Providers, including corrective action recommendations and education as needed.
• Serve as a liaison to Providers regarding coding updates, new services, documentation standards, and regulatory changes; must be able to present effectively to physician groups.
• Review all coding-related denials to identify trends, root causes, and systemic risks; recommend preventive strategies to reduce future denials.
• Review Athena coding rejections and validate relevance to FQHC encounters, eliminating non-applicable or payer-inaccurate edits.
• Collaborate with Billing Specialists to identify coding risks, compliance concerns, and documentation gaps that may impact reimbursement.
• Ensure appropriate use of CPT, HCPCS, ICD-10-CM, and FQHC-specific codes in accordance with payer and regulatory guidance.
• Prepare compliance, audit, and denial trend reports for the Revenue Cycle Manager and leadership.
• Travel to InclusivCare locations as needed to support onsite audits, provider education, or operational needs.
• Ensure compliance with HIPAA and all applicable federal and state regulations governing patient health information.
• Perform other duties as assigned by the Revenue Cycle Manager.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE: AAPC Coding Certification required. A minimum of three (3) years of professional medical coding experience is required. Experience in a Federally Qualified Health Center or community health center setting is recommended. Ongoing training related to FQHC coding, payer policy updates, and regulatory compliance are required annually for job retention.

KNOWLEDGE: Thorough understanding of ICD-10-CM, CPT, HCPCS, and FQHC-specific billing and coding guidelines. Knowledge of payer policies including Medicaid, Medicare, and commercial insurance products. Proficiency with electronic health record and practice management systems, including Athena. Strong computer skills, including Microsoft Excel and Word.

LANGUAGE SKILLS: Ability to read, analyze, and interpret medical records, coding guidelines, payer policies, and government regulations. Ability to effectively communicate coding concepts and audit findings to Providers and clinical leadership, both verbally and in writing.

MATHEMATICAL SKILLS: Ability to work with basic mathematical concepts such as percentages, ratios, and trend analysis as they relate to audit results and denial patterns.

REASONING ABILITY: Ability to define problems, collect and analyze data, establish facts, and draw valid conclusions. Ability to interpret complex coding and regulatory guidance and apply it to varied clinical scenarios.

CERTIFICATES, LICENSES, REGISTRATIONS: Current AAPC Coding Certification required.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions, with proper medical documentation/clearance, if applicable.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.