Clinical Coder & Medical Biller

Position Summary

The Member Experience Clinical Coder & Medical Biller serves as a key contributor to internal medical billing review, payment integrity, and claims adjudication. This role requires deep expertise in reviewing, validating, and repricing claims on behalf of payers, providers, and claim audit partners to support accurate reimbursement and strengthen payment integrity for our self-insured clients. You will translate medical diagnoses, procedures and services into standardized coding while ensuring compliance with established guidelines and reimbursement methodologies. In addition, you will collaborate closely with providers, Third-Party Administrators (TPA’s), and other stakeholders to identify coding discrepancies, provide analysis, and communicate findings that drive informed decision-making and optimal claim outcomes.

Key Responsibilities

Medical Coding & Documentation Review:

• Receive, analyze, and verify patient medical records for accuracy, ensuring all required information is present for proper billing and adjudication.
• Assign and sequence medical codes accurately in accordance with government, payer, and insurance regulations.
• Identify missing, incomplete, inaccurate, or potentially fraudulent data and follow up with claims staff, attorneys, or physicians to clarify and obtain necessary details.
• Gather supporting documentation to validate coding decisions and advocate for correction of wrongfully denied or incorrectly processed claims.

Claims Analysis & Accuracy:

• Review and evaluate claims, including diagnostic tests, consultations, procedures, treatments, and medications, to ensure all services are coded and billed appropriately.
• Analyze medical malpractice and complex claim scenarios to identify relevant diagnoses, events, and procedures that contributed to the outcome.
• Collaborate with claims examiners to ensure all medical records are processed correctly and payment determinations align with coding integrity standards.

Quality, Compliance & Coding Standards:

• Maintain strict adherence to medical coding guidelines, payer policies, and regulatory compliance requirements.
• Ensure documentation integrity, coding accuracy, and alignment with industry standards to support clean claim submission and reduce errors.
• Monitor coding trends to identify potential areas of risk or improvement in billing and reimbursement practices.

Process Improvement & Collaboration:

• Partner with internal teams including Member Experience, Claims, and Payment Integrity to resolve complex issues and ensure coding accuracy supports overall member and provider satisfaction.
• Identify opportunities to streamline coding workflows and contribute to best practices, policy updates, and training materials.

Recordkeeping & Reporting:

• Maintain accurate, organized, and compliant documentation of coding reviews, claim findings, and case outcomes in applicable systems.
• Prepare reports that highlight coding discrepancies, denial trends, and overall payment integrity insights.

Qualifications

Education and Experience:

• Degree in nursing with active unrestricted license.
• 2+ years of experience in the medical field working as a nurse coder or similar role.
• Knowledgeable in all medical coding guidelines.
• Currently active or eligible to obtain coding certifications.
• Ability to maintain a high level of integrity and confidentiality of medical information.
• Strong organizational skills.
• Strong computer, mathematics, data entry, and transcription skills.
• Authorized to work in the United States on a full-time basis without Company sponsorship.

Preferred       

• Experience with Reference-Based Pricing (RBP)

Specialized Knowledge or Licenses

• Certified Professional Coder (CPC) Preferred
• Certified In-Patient Coder (CIC) Preferred
• Certified Outpatient Coding (COC) Preferred
• Nursing License Active and Unrestricted Required

Salary for this position ranges from $115,000.00 - $150,000.00. The base pay offered will be determined on factors such as experience, skills, training, location, certifications, and education. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives. 

Qualifying positions will also be eligible for comprehensive benefits, such as participation in family medical and dental insurance programs, 401K plan, and PTO.

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Must be authorized to work in the United States on a full-time basis without Company sponsorship.

PERMA FAIR is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, gender, affectional or sexual orientation, gender identity or expression, national origin, ancestry, nationality, age, disability (physical or mental), marital or domestic partnership or Civil Union status, pregnancy, family medical history or genetic information, atypical cellular or blood trait, military service or any other status protected by law.