Certified Professional Coding Specialist

Certified Professional Coding Specialist 3.8 3.8 out of 5 stars Miramar Beach, FL 32550 Full-time Labarium Diagnostic Systems, Inc. 10 reviews Full-time

LABARIUM DIAGNOSTIC SYSTEMS, INC.

Certified Professional Coding Specialist Department:

Revenue Cycle Management Reports To:

Revenue Cycle Manager Location:

Miramar Beach, FL or Milledgeville, GA FLSA:

Non-Exempt

POSITION SUMMARY

The Certified Professional Coding Specialist is responsible for the accurate and timely submission of claims and the coding and billing of clinical laboratory services for Labarium Diagnostic Systems, Inc. This individual evaluates medical records and charge entries to ensure completeness, accuracy, and compliance with ICD-10-CM, HCPCS, and CPT code sets. The Specialist also provides technical guidance, education, and training to the Revenue Cycle Management (RCM) team to support coding quality and regulatory compliance across the organization.

KEY RESPONSIBILITIES

Apply professional judgment and coding expertise to evaluate and correct code assignment issues, ensuring accurate and compliant claim submission. Evaluate medical record documentation and coding to optimize reimbursement by ensuring that clinical laboratory codes and supporting documentation accurately reflect and support CPT, ICD-10-CM, and HCPCS policies in accordance with legal standards and guidelines. Interpret medical information — including diagnoses, symptoms, and procedures — to assign and sequence correct ICD-10-CM and CPT codes accurately and in compliance with official coding guidelines. Review documentation to identify missing or inaccurate billing codes and communicate education needs to the appropriate clinical or billing staff. Perform monthly random billing compliance audits of claims and progress notes to proactively identify potential billing discrepancies and compliance risks. Make recommendations for updates to policies and procedures; collaborate with the RCM team and staff to revise and maintain the chargemaster file. Review state and federal Medicare reimbursement guidelines and clean claim requirements to ensure completeness and accuracy of claims prior to submission, minimizing denials. Evaluate records and prepare management reports on coding-related denial trends, billing discrepancies, and other findings for review by leadership and professional evaluation committees. Provide technical guidance in identifying and resolving coding issues including incomplete or missing diagnoses, ambiguous or nonspecific documentation, and codes that do not conform to approved coding principles and guidelines.

REQUIRED QUALIFICATIONS

High school diploma or equivalent required; Associate's degree in Healthcare Administration or a related field preferred. Active Certified Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC) required; certification must be maintained in good standing as a condition of employment. Minimum 2 years of experience in professional medical record coding services, preferably in a clinical laboratory or outpatient setting. Thorough knowledge of ICD-10-CM and CPT coding guidelines, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement regulations. Demonstrated ability to research and analyze data, draw conclusions, resolve coding and billing issues, and apply applicable policies, procedures, laws, and regulations. Ability to read, interpret, and accurately code medical procedures, diagnoses, and clinical terminology from medical records and laboratory documentation. Strong capacity for independent judgment and decision-making in a compliance-sensitive environment. High attention to detail with strong organizational and time management skills.

PREFERRED QUALIFICATIONS

Experience with clinical laboratory-specific billing, including familiarity with Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for laboratory services. Prior experience with pharmacogenomics (PGx) or molecular diagnostic coding and applicable payer coverage policies. Experience with chargemaster review, maintenance, and updates in a laboratory or outpatient billing environment. Familiarity with laboratory information systems (LIS) and billing platform integrations.

WORK LOCATION

Work Location Note:

This is a 100% on-site position based at Labarium's Miramar Beach, Florida office. Candidates must be able to commute to this location daily. Remote work and telecommuting are not available for this role.

Benefits:

Relocation assistance

Work Location:

In person