Job Overview:

Our client is looking for a Medical Coder - Telehealth & Transitional Care Management (TCM) (CPC/CCS) who is responsible for accurately reviewing, coding, and submitting medical claims for Transitional Care Management (TCM) services delivered through telehealth. This role ensures compliance with CMS, Medicare, Medicaid, and commercial payer guidelines while supporting timely reimbursement and maintaining the integrity of clinical documentation. The Certified Medical Coder works closely with healthcare providers, clinical staff, and billing personnel to optimize revenue cycle performance and ensure quality patient care.

Schedule:

Monday - Friday, 8:00 AM - 5:00 PM Central Time, with 1 hour unpaid break (40 work hours per week)

Responsibilities:

• Review patient medical records, provider documentation, and telehealth encounter notes for completeness and coding accuracy.
• Assign appropriate ICD-10-CM, CPT, and HCPCS codes for Transitional Care Management and related telehealth services.
• Ensure compliance with CMS regulations for TCM services, including required communication timelines, face-to-face visit requirements, and documentation standards.
• Verify medical necessity and ensure coding supports services rendered.
• Identify documentation deficiencies and collaborate with providers to obtain necessary clarifications.
• Submit clean claims and assist in resolving coding-related claim denials and payer inquiries.
• Perform regular coding audits to ensure accuracy and regulatory compliance.
• Stay current with annual coding updates, Medicare regulations, payer policies, and telehealth reimbursement requirements.
• Maintain patient confidentiality in accordance with HIPAA and organizational policies.
• Assist with quality improvement initiatives and coding education for clinical staff.
• Collaborate with billing and revenue cycle teams to improve reimbursement and reduce claim rejections.
• Maintain productivity and accuracy standards established by the organization.

Performance Expectations:

• Maintain coding accuracy consistent with organizational quality standards.
• Meet productivity benchmarks for record review and claim submission.
• Support compliance initiatives through accurate documentation review and coding practices.
• Contribute to reducing claim denials and improving reimbursement outcomes.
• Participate in ongoing education and maintain active coding certification.

Requirements:

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), or equivalent coding certification.
• High school diploma or GED required; associate degree in Health Information Management or related field preferred.
• Minimum of 2 years of medical coding experience, preferably in primary care, care management, or telehealth.
• Strong knowledge of ICD-10-CM, CPT, HCPCS Level II coding systems.
• Thorough understanding of Medicare, Medicaid, and commercial payer regulations.
• Experience with Electronic Health Records (EHR) and practice management software.
• Excellent attention to detail and analytical skills.
• Strong written and verbal communication skills.
• Ability to work independently in a remote or hybrid environment while meeting productivity goals.

Qualifications:

• Experience coding Transitional Care Management.
• Knowledge of Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Principal Care Management (PCM), and telehealth billing.
• Familiarity with value-based care models and quality reporting programs.
• Experience with coding audits and compliance reviews.

Knowledge, Skills, and Abilities:

• Advanced understanding of medical terminology, anatomy, and physiology.
• Knowledge of HIPAA, OIG compliance, and CMS documentation requirements.
• Strong organizational and time-management skills.
• Ability to prioritize multiple tasks while maintaining coding accuracy.
• Proficiency with Microsoft Office and healthcare software applications.

Independent Contractor Perks:

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note:

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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