Medical Billing and Coding

• Responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters.
• Ensure coding accuracy, regulatory compliance, appropriate reimbursement, and adherence to client-specific coding guidelines, payer requirements, and industry standards.
• Review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits.
• Accurately assign facility Evaluation and Management (E/M) levels in accordance with client-specific emergency department leveling guidelines and facility charging methodologies, including knowledge of the ACEP tool.
• Analyze documentation from nursing staff, physicians, ancillary departments, and diagnostic services to ensure complete code assignment and charge capture.
• Apply official coding guidelines, CMS regulations, National Correct Coding Initiative (NCCI) edits, and payer-specific requirements.
• Participate in coding quality reviews, audits, educational initiatives, and process improvement activities.

Emergency Department Medical Coder

• Review and code patient records for both inpatients and outpatients
• Assign appropriate ICD-10-CM and ICD-10-PCS codes
• Verify CPT-4 codes, DRGs, and APCs

Credentialed Coder, Certified

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• Create and write reports based on medical records and appropriate guideline criteria
• Analyze provider billing for proper coding and billing guidelines
• Perform quality assurance on every case prior to completion
• Ensure all medical records and reports are properly documented and available for audit
• Process client invoicing in accordance with the client’s fee schedule
• Contact client as needed for inquiries
• Provide testimony in court as to the content of prepared reports, as required

Medical Coding Specialist

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with unclear, or unsubstantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Outpatient Surgery Coder

• Prepare, review, and submit clean medical claims to commercial payers.
• Verify claim accuracy, including coding, modifiers, eligibility, EAP authorizations, and provider details
• Monitor claim rejections and take timely corrective actions
• Manage denial resolution: research root cause, correct and resubmit, or prepare appeals
• Conduct proactive follow-up on outstanding A/R and aging claims
• Support patient billing activities and inquiries when needed
• Document all billing activities clearly and accurately in internal systems
• Ensure compliance with HIPAA, payer regulations, and state/federal billing guidelines
• Collaborate with credentialing, eligibility/benefits, clinical operations, and internal RCM teammates
• Identify trends and recommend process improvements to reduce denials and rework

Medical Billing Specialist

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• Under general supervision and according to established policies and procedures, reviews and abstracts the demographic, financial and clinical data from the inpatient medical record for the purpose of assigning ICD diagnosis/procedures, HCPCS, and CPT.
• Ensures that inpatient and outpatient records are coded, abstracted and entered into computer system in an accurate and timely manner.

Coder Abstractor, Certified

• Codes and abstracts professional fee hospital services from medical records according to guidelines
• Utilizes 3M Encoder for validation of RVUs and procedure unbundling
• Maintains a 95% coding accuracy rate

Emergency Department Medical Coder – Per Diem

• Code medical records to validate ICD-10-CM codes for PACE Risk Adjustment
• Meet department production and quality standards
• Research regulatory guidelines for supporting documentation
• Prepare coding reports using excel
• Prepare oral and/or written reports of work activity to Supervisor
• Be responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information.
• Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach
• Other duties as assigned

Risk Adjustment Coder

• Responsible for supervising the work of staff who review, interpret, code and abstract medical records information according to standard classification systems.
• Performs the most advanced medical records coding and abstraction duties.
• Performs data quality reviews and prepares complex reports as required.
• Promotes Coding Audit department goals by selecting, motivating, and training capable team members.
• Leads the activities of assigned Coding Audit team members by communicating and providing guidance toward achieving department objectives.
• Assists in analyzing common operational definition of metrics and assists in the development of regional reports to monitor individual hospitals in one database and develops processes to integrate clinical department managers in correction and resubmission of medical records.
• Assists with the development of tools to track performance including daily reports that track coding operations contribution to the DNFB, including progress toward the resolution of holds; applies data-driven methodologies to understand the current state of coding operations relating to individual hospitals.
• Compiles data into reports to identify trends and patterns in procedures; provides regional and local metric information for organization communications.
• Evaluates and implements systems, mechanisms, and procedures that ensure timely placement of documents in the patient medical record.
• Measures adherence of system(s) developed, handle delays and errors; ensures adherence to high-quality Medical Records standards.
• Assists the leadership in development of performance goals, dashboards and medical record chart assembly / delivery procedures; utilizes and reviews tools to track and monitor the prompt resolution of holds and non-coded accounts.
• Collaborates with site leadership to prioritize, schedule, assign, and monitor work to optimize operational services; maintains compliance with the policies, procedures and regulations of Medical Records; informs and educates staff of regulatory changes, as needed.
• Communicates case write-offs with senior leadership and Business Offices; supervises, hires, trains, disciplines, and evaluates the performance of staff; ensures performance appraisals are completed in a timely manner.
• Prioritizes, schedules, assigns and monitors work to optimize operational services; participates in developing and delivering training related to operations.
• Performs other related duties as assigned.

Medical Coding Supervisor

• Manages multiple EPIC work queues (WQs) to ensure timely billing and resolution of all encounters within 2–3 days.
• Monitors and audits coder performance, ensuring >/= 95% coding and DRG accuracy through regular reviews, meetings, and feedback sessions.
• Educates and mentors coding staff, providing onboarding for new coders, daily coaching, and monthly team meetings to maintain accuracy and compliance.
• Acts as a liaison between the Coding Division, CDI Program, physicians, and Revenue Integrity to improve documentation, query processes, and charge accuracy.
• Conducts daily coding audits and reviews all PSI, Vizient, and 3M data to validate coding accuracy, case quality, and performance metrics.
• Oversees the DRG validation and denial management program, resolving coding disputes and ensuring documentation supports accurate reimbursement.
• Applies national coding standards and metrics, maintaining expertise in SOI/ROM, AHRQ PSI criteria, NTAP cases, and Medicare reimbursement systems.
• Stays current on industry updates, including Medicare PPS changes, Coding Clinic guidance, and emerging trends such as SDOH and COVID-related coding.
• Drives process improvement initiatives, collaborating with CDI, Quality, and ER leaders to enhance documentation, reduce denials, and improve national quality ratings.
• Performs coding duties as needed, supporting workload balance, reducing discharged-not-billed (DNB) cases, and meeting monthly performance goals

Lead Coding Specialist

• Codes and abstracts diagnosis and procedure information from patient medical records according to AHA ICD-10-CM/PCS coding conventions, UHDDS and CMS guidelines and regulations
• Utilizes the 3M Encoder to verify and assign AHA ICD-10-CM/PCS codes, and MS-DRG/APR-DRG assignment
• Maintains 95% data quality coding accuracy rate as measured through quarterly department quality reviews
• Maintains daily productivity and turnaround times
• Responsible for remaining up-to-date with knowledge of AHA ICD-9-CM/ICD-10-CM/PCS coding conventions, MS-DRG and APR-DRG principles and guidelines
• Maintains a working knowledge of prospective payment systems as it relates directly to coding process
• Participation in department and sectional meetings, education sessional sessions and workshops as scheduled
• Maintains working knowledge of clinical documentation improvement program and functions as liaison for RN clinical documentation specialists
• Demonstrates/models the Network’s core values and customer service behaviors in interactions with all customers (internal and external)
• Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information.

Medical Billing and Coding jobs in New Jersey

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