Clinical Coding Specialist – Submission

About the role

The Clinical Coding Specialist – Submission is responsible for reviewing patient medical records, abstracting clinical information, and assigning accurate diagnostic and procedural codes. This role ensures compliance with coding standards, supports reimbursement processes, and contributes to revenue integrity.

Key responsibilities

• Review and analyze patient medical records to extract pertinent clinical data.
• Assign appropriate ICD‑10, CPT, and E&M codes for diagnosis, procedures, and pre‑authorization purposes.
• Query physicians when documentation is unclear or coding assignments are ambiguous.
• Audit medical claims for accuracy, payer compliance, and billing standards.
• Collaborate with coders, billers, physicians, and operational teams to resolve claim‑related issues.
• Maintain up‑to‑date knowledge of coding guidelines, regulatory requirements, and industry changes.
• Prepare coding data for quality assurance and medical audit activities.

Required profile

• Bachelor’s degree in Health Information Management or a related field (or a diploma with at least 3 years of relevant experience).
• Experience in clinical coding, medical record review, or healthcare billing.
• Master’s degree or equivalent in Health Information Management is desirable.

Required skills

• Clinical coding systems (ICD‑10, CPT, E&M).
• Medical claims auditing and compliance.
• Knowledge of regulatory and accreditation standards.
• Ability to query and communicate effectively with physicians regarding documentation.