SPE-Medical Coding HC

Job Summary

This hybrid role is for a skilled medical coding specialist who supports high quality healthcare products through accurate clinical data translation and validation. The specialist applies medical coding expertise to maintain coding integrity improve claims efficiency and enhance patient centric solutions while collaborating with cross functional teams in a structured day shift environment without travel.

Responsibilities

• Review medical records from diverse healthcare products to assign accurate standardized codes that support compliant billing and robust clinical analytics
• Apply deep knowledge of medical coding guidelines to validate coded data for completeness consistency and proper linkage to healthcare product features
• Collaborate with product teams to translate clinical documentation into structured codes that strengthen the reliability and usability of healthcare solutions
• Analyze coding discrepancies to identify root causes communicate findings and support corrective actions that reduce rework and claim denials
• Coordinate with quality and operations teams to refine coding workflows that enhance turnaround time without compromising clinical and regulatory accuracy
• Conduct detailed audits of coded encounters to ensure alignment with payer requirements regulatory standards and internal compliance policies
• Document coding rationales in a clear and traceable manner so downstream users can easily understand decisions and apply them consistently
• Contribute to continuous improvement efforts by sharing coding insights that influence product design documentation templates and rules based engines
• Use medical coding expertise to support testing of healthcare product enhancements ensuring that coding rules and edit logic behave as intended
• Respond to inquiries from internal stakeholders regarding code selection and documentation needs while promoting a culture of quality and accountability
• Monitor performance metrics for coding productivity and quality and suggest practical adjustments that help meet or exceed service level agreements
• Engage in regular knowledge updates on medical coding standards payer bulletins and healthcare product changes to keep daily work aligned with current expectations
• Support knowledge sharing through participation in team huddles calibration sessions and feedback loops so that coding practices remain consistent and scalable
  
  

Qualifications

• Possess practical experience in medical coding over at least two years with strong exposure to healthcare products in a professional delivery environment
• Demonstrate proficiency in applying coding standards including current clinical classification systems used across major healthcare products and payer workflows
• Exhibit strong understanding of healthcare product life cycles including how coded data feeds into claims processing quality reporting analytics and compliance checks
• Display proven ability to interpret clinical documentation from multiple care settings and convert it into precise codes that support accurate reimbursement and reporting
• Show familiarity with electronic health record platforms and coding tools commonly deployed in hybrid work models to maintain secure and efficient coding operations
• Communicate clearly with multidisciplinary teams including clinical operations and product stakeholders to clarify documentation gaps and coding questions
• Maintain a continuous learning mindset to keep medical coding competencies aligned with evolving clinical guidelines payer rules and organizational quality goals
  
  

Certifications Required

Certified Professional Coder CPC or equivalent medical coding certification from a recognized body