Medical Billing Coder I

Position:

Medical Billing Coder I Exemption Status:

Non-Exempt Reporting Relationship:

Billing Lead, Supervisor, or Manager Direct Reports:

None Work Environment:

Office-Based Position Summary The Medical Billing Coder I is responsible for reviewing, analyzing, and coding patient medical documentation to support accurate billing, reimbursement, and regulatory compliance. This position translates clinical documentation into standardized medical codes and ensures claims are complete, accurate, and supported by appropriate documentation prior to submission. The Medical Billing Coder I plays a critical role in reducing claim denials, supporting revenue cycle performance, and ensuring patients are billed appropriately according to payer and government guidelines. This role collaborates with providers, claim resolution specialists, insurance representatives, and clinic staff to resolve coding issues, improve documentation quality, and support timely reimbursement. Essential Duties and Responsibilities Core Functional Responsibilities Review assigned claims to ensure accurate coding and claim submission prior to billing. Analyze provider documentation, clinical notes, and electronic medical records to assign appropriate ICD-10-CM, CPT, and HCPCS codes. Abstract and compile provider documentation, coding information, and claim data necessary for reimbursement. Ensure assigned codes accurately reflect services rendered and support medical necessity requirements. Review claims for missing, incomplete, vague, or inconsistent documentation and obtain clarification as needed. Complete coding corrections, billing adjustments, rebill requests, and claim updates as necessary. Sequence codes according to payer, government, and organizational requirements. Review denied or rejected claims to determine root cause and identify corrective actions. Research payer requirements and communicate with insurance representatives regarding claim denials and reimbursement issues. Request and upload required documentation to patient accounts and payer systems. Validate payer information and verify patient eligibility when applicable. Identify documentation deficiencies and communicate concerns to providers and applicable staff. Monitor coding edits, payer trends, and denial patterns to support process improvement efforts. Share coding trends, denial patterns, and process improvement opportunities with leadership and team members. Support development of workflow improvements, SOPs, visual aids, and coding process enhancements. Collaboration and Communication Collaborate with Claim Resolution Specialists, providers, clinic staff, and leadership to resolve coding and reimbursement issues. Mentor and support Claim Resolution Specialists by helping improve information gathered upfront to reduce denials. Communicate professionally and effectively with providers, coworkers, patients, insurance representatives, and external partners. Answer provider questions accurately and provide constructive feedback to improve documentation quality. Compliance and Quality Maintain compliance with HIPAA, Medicare, Medicaid, commercial payer requirements, and organizational policies. Maintain current knowledge of coding guidelines, payer requirements, regulatory updates, and reimbursement practices. Ensure proper filing, handling, and confidentiality of protected health information (PHI). Follow all company policies, procedures, and departmental standards. General Expectations Meet established productivity, quality, and timeliness standards. Demonstrate professionalism, adaptability, accountability, and sound judgment. Participate in department meetings, training, and special projects as assigned. Perform other duties as assigned. Success Indicators / Key Performance Metrics Success in this role may be measured by: Coding accuracy and audit results Productivity standards and number of claims processed Claim acceptance and rejection rates Charge review turnaround time Top performers consistently demonstrate high coding accuracy, low rejection rates, timely claim processing, strong problem-solving skills, and proactive communication with providers and team members. Required Qualifications Education High school diploma or GED equivalent required Experience Minimum one (1) year of experience in medical billing, coding, accounts receivable, denial resolution, or related healthcare revenue cycle functions Experience reviewing EOBs, resolving denial issues, or working with CPT coding preferred Experience interacting and communicating effectively with providers and staff in a professional healthcare environment Certifications/Licensure CPC-A certification required within two (2) years of employment Technical Skills Experience using EMR/EHR systems required; EPIC experience preferred Proficiency with Microsoft Office applications Experience navigating insurance web portals Accurate typing and data entry skills Basic knowledge of ICD-10-CM, CPT, HCPCS, medical terminology, anatomy, and payer guidelines Preferred Qualifications Prior coding experience in Medicare, Medicaid, commercial, private, or OB specialties Experience working in Federally Qualified Health Centers (FQHCs) or healthcare clinic environments Additional coding certifications preferred Working Conditions / ADA Requirements Prolonged sitting and computer use Frequent keyboarding and repetitive hand motions Frequent visual concentration and attention to detail Ability to maintain concentration in a fast-paced environment Ability to communicate effectively verbally and in writing Occasional lifting up to 25 pounds Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required. Responsibilities may change based on organizational needs.