Medical Coder and Biller The Kairos Group Chesapeake, VA Job Details Full-time From $24.50 an hour 6 days ago Qualifications Computer operation Anatomy knowledge Medicare Computer literacy HIPAA High school diploma or GED Electronic health record (EHR) management for billing and coding Centers for Medicare & Medicaid Services (CMS) billing regulations Computer skills Medicaid regulations Medical claims submission Medicaid Clinical confidentiality policies Clinical documentation standards Medical terminology Documentation review Full Job Description

JOB SUMMARY

The Medical Coder is responsible for reviewing medical records and clinical documentation and assigning accurate ICD-10-CM, CPT, and HCPCS codes for outpatient healthcare services. This position plays a critical role in supporting accurate billing, timely reimbursement, compliance, and revenue-cycle operations for services provided to Medicaid, Medicare, commercial insurance, and other third-party payers. The Medical Coder will support healthcare services that may include HIV prevention and treatment, HIV/STI testing, PrEP/PEP services, primary care, behavioral health services, preventive care, laboratory services, counseling, and other ambulatory healthcare services. The position requires a strong understanding of medical documentation, outpatient coding, Medicaid billing requirements, and the relationship between clinical documentation, coding, claims submission, and reimbursement. The Medical Coder will utilize Athenahealth and Practice Fusion to review patient records, evaluate provider documentation, assign appropriate codes, identify documentation deficiencies, and support accurate claim submission. The Medical Coder will also work in an environment where certain services and medications may be supported through 340B-related healthcare programs . The coder must understand the importance of accurate documentation and coding to support appropriate billing, reimbursement, reporting, and program compliance while recognizing that medical coding and 340B medication program administration are separate functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Medical Record Review & Coding Review electronic medical records in Athenahealth and Practice Fusion to determine the appropriate diagnosis and procedure codes. Assign accurate ICD-10-CM, CPT, and HCPCS codes based on provider documentation. Review office visits, preventive services, consultations, laboratory services, procedures, screenings, testing, and other billable services. Verify that reported diagnoses and procedures are supported by the medical record. Identify documentation deficiencies that may affect coding, billing, reimbursement, or compliance. Ensure coding accurately reflects the services actually provided. Apply current official coding guidelines and payer-specific requirements. Review records for appropriate documentation before claims are submitted. The coder must accurately distinguish between diagnoses, screening encounters, confirmed conditions, symptoms, preventive services, and other documented reasons for the encounter. Medicaid & Third-Party Payer Coding Apply appropriate coding practices for Medicaid, Medicare, commercial insurance, and other third-party payers . Review payer-specific requirements that affect coding and reimbursement. Identify coding errors that may result in claim denials, rejections, underpayments, or delayed reimbursement. Assist the billing team with researching coding-related claim denials. Correct coding errors when appropriate and supported by documentation. Identify recurring Medicaid or payer-related coding issues and communicate them to management. Maintain awareness of changes in applicable payer policies and coding requirements. 340B-Related Healthcare Services Support accurate coding and documentation for encounters involving patients who receive services associated with a 340B-covered entity or 340B-supported healthcare program . Ensure medical services are accurately coded based on the clinical documentation. Coordinate with billing, pharmacy, clinical, and administrative personnel when coding information intersects with 340B-supported services. Maintain a clear understanding that medical coding, claims billing, and 340B drug-program administration are distinct functions . Assist with documentation and coding reviews that support appropriate billing, reimbursement, reporting, and program integrity. Escalate discrepancies or questions involving patient eligibility, payer requirements, pharmacy services, or 340B program processes to the appropriate department rather than independently making determinations outside the coder's scope. Athenahealth & Practice Fusion Navigate and review patient records in Athenahealth and Practice Fusion . Review encounter notes, diagnoses, orders, laboratory results, procedures, medications, and other relevant clinical documentation. Enter or verify appropriate billing codes within applicable systems. Identify discrepancies between provider documentation and coded services. Communicate documentation questions to providers or designated clinical personnel. Maintain accurate electronic documentation and coding records. Protect patient information and maintain HIPAA compliance when accessing electronic health records. Documentation Integrity Review provider documentation for completeness, clarity, and consistency. Identify instances where documentation does not adequately support the assigned code. Initiate appropriate provider queries when clarification is required. Never code diagnoses or services that are not supported by documentation. Maintain a clear distinction between clinical documentation and coding interpretation. Escalate significant documentation concerns to the appropriate supervisor or compliance personnel. Compliance & Confidentiality Maintain strict confidentiality of patient information. Comply with HIPAA and organizational privacy policies. Follow applicable federal and state healthcare regulations. Follow current coding guidelines and organizational coding policies. Participate in coding audits and quality assurance activities. Report suspected coding, billing, documentation, or compliance concerns through appropriate organizational channels. Maintain professional boundaries when handling protected health information.

KNOWLEDGE, SKILLS AND ABILITIES

The successful candidate should possess knowledge of:

ICD-10-CM

coding. CPT coding. HCPCS Level II coding. Outpatient/ambulatory medical coding. Medical terminology. Anatomy and physiology. Clinical documentation requirements. Healthcare billing and reimbursement. Medicaid billing practices and payer requirements. Medicare and commercial insurance billing principles. HIV/AIDS-related medical terminology and services. STI testing, screening, diagnosis, and treatment terminology. PrEP and PEP terminology and related clinical services. Preventive health services. Laboratory and diagnostic services. HIPAA and patient privacy requirements. Electronic health records and practice management systems. Revenue-cycle processes. Basic principles of healthcare compliance. General awareness of the 340B Drug Pricing Program and the distinction between 340B program administration and medical coding. Skills Advanced medical record review skills. Accurate ICD-10-CM, CPT, and HCPCS coding. Strong attention to detail. Strong analytical and problem-solving skills. Ability to interpret clinical documentation. Ability to identify documentation and coding discrepancies. Strong understanding of outpatient billing workflows. Ability to research payer and coding requirements. Strong written and verbal communication skills. Strong computer skills. Ability to work efficiently in Athenahealth and Practice Fusion . Ability to maintain accuracy while meeting productivity expectations. Ability to identify potential causes of claim denials and billing delays. Abilities Ability to work independently and manage an assigned coding workload. Ability to meet established productivity and accuracy standards. Ability to prioritize work based on organizational deadlines. Ability to communicate effectively with providers, billing personnel, clinical staff, and management. Ability to maintain confidentiality regarding sensitive patient information. Ability to recognize when documentation requires clarification. Ability to exercise sound professional judgment within the scope of the coding position. Ability to adapt to changes in coding guidelines and payer requirements. Ability to work effectively in a fast-paced healthcare environment.

MINIMUM QUALIFICATIONS

High school diploma or equivalent required. Completion of a medical coding, medical billing and coding, health information management, or related healthcare program preferred. Minimum of two (2) years of professional medical coding experience in an outpatient, physician practice, community health center, federally qualified health center, HIV/STI clinic, or similar healthcare setting preferred. Demonstrated working knowledge of ICD-10-CM, CPT, and HCPCS coding systems. Experience reviewing electronic medical records and clinical documentation. Experience with healthcare claims and billing processes. Working knowledge of Medicaid billing requirements. Working knowledge of medical terminology, anatomy, and physiology. Experience working with an EHR system. Strong computer skills. Ability to maintain HIPAA confidentiality. Must satisfactorily pass a background check.

PREFERRED QUALIFICATIONS

Certified Professional Coder (CPC) through AAPC. Certified Coding Specialist (CCS) through AHIMA. Certified Coding Associate (CCA) or comparable recognized coding credential. Two or more years of outpatient medical coding experience. Experience coding HIV/AIDS-related services. Experience coding STI testing and treatment services. Experience with PrEP and/or PEP services. Experience working with Medicaid. Experience with community health centers or similar safety-net healthcare environments. Experience with Athenahealth . Experience with Practice Fusion . Experience with medical billing and denial management. Familiarity with 340B-covered entities or healthcare organizations participating in the 340B program.

CONFIDENTIALITY

Because this position has access to protected health information and other confidential healthcare information, the Medical Coder must maintain strict confidentiality and comply with HIPAA, organizational policies, and all applicable privacy requirements. This role is ideal for motivated professionals eager to leverage their coding expertise within a fast-paced healthcare environment. We value accuracy, transparency, and continuous learning—qualities that drive success in this essential position. Join us to make a meaningful difference by ensuring precise billing practices that support quality patient care!

Pay:

From $24.50 per hour Expected hours: 40.0 per week

Work Location:

In person