Review clinical documentation and diagnostic results to ensure accurate CPT and ICD-10 coding.
Validate medical necessity and ensure coding aligns with CMS and payer-specific guidelines.
Process charge captures and review billing system edits to prevent claim denials.
Collaborate with providers and billing teams to clarify documentation or coding inconsistencies.
Identify coding trends, resolve payer denials, and provide recommendations for improvement.
Assist with provider education on documentation and coding compliance.
Maintain production standards and report daily coding productivity and quality metrics.

High School Diploma or GED required.
Completion of a formal coding program (AHIMA, CCS, or AAPC preferred).
Minimum of 3 years’ applied coding experience OR 5 years of OB/GYN coding experience in a physician billing or revenue cycle setting; Emphasize on OB/GYN coding!
Proficiency in ICD-10, CPT, medical terminology, anatomy, and health record content.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) preferred.
Non-certified coders with strong experience may be required to obtain certification within an agreed timeframe.
In-depth knowledge of Medicare, Medicaid, and managed care plans (HMO, PPO, POS, Indemnity).
Understanding of HIPAA, Medicare Fraud and Abuse regulations, and EHR/Billing systems.
Strong analytical and organizational skills with attention to detail.
Proficiency in Microsoft Office (Word, Excel, Outlook) and healthcare billing platforms.
Excellent verbal and written communication skills.
Customer-focused approach and ability to work effectively with clinical staff and patients.

Medical Biller/Coder, OB/GYN

Key skills