Job Description
At Restore First Health, we are dedicated to providing advanced, in-home wound care through a holistic approach that emphasizes collaboration, communication, and care coordination. Our mission is to improve health outcomes by delivering innovative, patient-centered care.
We are seeking a Medical Coder to provide support to our Revenue Cycle Management team!
Position Summary: The Medical Coder is responsible for reviewing, analyzing, and accurately assigning medical codes to diagnoses, procedures, and services for telehealth, wound care, and acute care encounters in compliance with ICD-10-CM, CPT®, HCPCS Level II, and payer-specific guidelines. This role ensures optimal reimbursement, supports compliance with federal and state regulations, and contributes to timely and accurate claim submission.
Key Responsibilities:
- Coding & Documentation Review
- Assign accurate and complete ICD-10-CM, CPT®, and HCPCS Level II codes for telehealth, wound care, and acute care services.
- Review medical documentation for completeness and clarity, querying providers as needed for missing or ambiguous information.
- Validate medical necessity and ensure codes align with payer-specific and CMS Local Coverage Determinations (LCDs), particularly for wound care procedures such as debridement and skin substitute application.
- Apply correct telehealth modifiers (e.g., 95, FQ, FR) and place-of-service codes per CMS and commercial payer requirements.
- Compliance & Quality Assurance
- Maintain coding compliance with Medicare, Medicaid, and commercial payer guidelines.
- Conduct regular self-audits to ensure accuracy and adherence to internal and external coding policies.
- Support internal audits related to acute care, wound care, and telehealth encounters, providing education to providers and staff on documentation improvement opportunities.
- Reimbursement & Revenue Cycle Support
- Collaborate with the billing team to resolve coding-related claim rejections and denials.
- Identify opportunities to improve revenue capture through accurate coding and documentation practices.
- Assist in denial management by providing detailed coding rationales for appeals.
- Communication & Education
- Educate clinicians on documentation requirements to support accurate code assignment and reimbursement.
- Communicate changes in coding guidelines, LCD updates, and payer policies related to telehealth, wound care, and acute care services.
Qualifications:
- A high school diploma or equivalent is required; an associate’s or bachelor’s degree in health information management is preferred.
- Current certification from an accredited coding organization (e.g., CPC, COC, CIC, CCS, CCS-P).
- Minimum 3-5 years of coding experience in a healthcare setting, preferably in wound care, acute care, and telehealth.
- Strong knowledge of CPT®, ICD-10-CM, and HCPCS Level II coding guidelines.
- Familiarity with Medicare LCDs for wound care and telehealth regulations.
- Proficiency with EMR/EHR systems and coding/billing software.
- Strong analytical, organizational, and time-management skills.
- Excellent verbal and written communication skills.
- Ability to work independently and maintain strict confidentiality.
At Restore First Health, we are committed to work-life balance and a positive work environment that supports the well-being of every team member. We offer:
Benefits:
- Paid holidays.
- Paid Time Off
- 401(k) with company match.
- Health, dental, and vision insurance options.
- And More!
Our Culture and Values: At Restore First Health, we believe that exceptional patient care starts with a strong, compassionate team. Our values emphasize:
- Collaboration: Working closely with healthcare professionals, home health agencies, and skilled nursing facilities to ensure seamless wound care delivery.
- Care Coordination: Partnering with physicians, specialists, and home care providers to optimize patient outcomes.
- Communication: Prioritizing real-time updates and clear documentation to align all members of the care team.
- By joining Restore First Health, you will be part of an innovative, patient-focused team dedicated to improving lives through advanced wound care
Job Tags
Full time, Local area,