Medical Coder II/III

Role Overview

• Serve as the internal and external Subject Matter Expert (SME) on medical coding and billing across assigned service lines.
• Review and validate model-generated CPT, ICD-10-CM, HCPCS, and E&M codes
• Perform high-quality coding and auditing on inpatient, outpatient, ED, or pro-fee encounters (depending on specialty)
• Ensure documentation fully supports coding decisions in alignment with AMA, CMS, and payer guidelines
• Identify missed codes, incorrect E/M leveling, modifier errors, and insufficient documentation
• Analyze and document customers’ coding practices and workflows to facilitate optimal use of the CodaMetrix product.
• Identify and share Codametrix’s best practices for coding automation and workflow improvements with the customer.
• Present audit results to customer stakeholders and facilitate sign-off for go-live milestones.
• Assist manager with Coding Quality Assessment (CQA) projects, including work assignments, training, and quality assurance for offshore coding staff.
• Leverage CodaMetrix coding standards to drive world-class coding quality and consistency.
• Work with product and engineering to provide precise, consistent feedback on model training and data annotation
• Continuously improve evaluation and training materials on coding and billing to colleagues and customers.
• Share knowledge throughout CodaMetrix to build internal competencies and champion continuous improvement initiatives.
• Provide expert guidance on coding and billing questions to support Machine Learning and Product teams.
• Proactively stay up to date with changes in medical coding and billing by maintaining relevant certifications and participating in ongoing education.
• Uphold all legal and ethical requirements, ensuring accuracy, confidentiality, and compliance in all coding and audit activities.
• Help explain model decisions, error analyses, and coding rationales to clients
• Support customer success and implementation teams in understanding coding outputs
• Prepare clear written summaries of coding patterns, documentation issues, or model behavior
• Collaborate with cross-functional teams—such as Data Science, Product, and Customer Success—to address client needs and optimize results.

Requirements

• Current AHIMA or AAPC coding credential held for 3+ (level II) or 5+ years (level III).
• 3-5 (level II) or 5+ years (level III) of coding and auditing experience with progressive growth in responsibilities.
• Strong understanding of CPT, ICD-10-CM, HCPCS, modifiers, and 2023 E/M guidelines
• Experience in one of the following specialties: Professional hospital coding; specifically in Surgery, Endoscopy, Hospitalist, Cardiology, Emergency coding
• Demonstrated ability to interpret clinical documentation and identify gaps
• Excellent communication and customer service skills, capable of effectively engaging executives, directors, data scientists, and other stakeholders with varying levels of coding knowledge.
• Ability to translate complex coding guidelines to non-clinical team members.
• Strong organizational and detail-oriented approach with a demonstrated commitment to excellence and precision.
• Critical thinking, intellectual curiosity, and creativity in problem-solving.
• Ability to thrive under time constraints in a fast-paced environment.
• Team-oriented approach with a positive and patient demeanor, fostering collaboration and continuous improvement.

Benefits

• Health Insurance: We cover 80% of the cost of medical and dental insurance and offer vision insurance
• Retirement: We offer a 401(k) plan that eligible employees can contribute to one month after their first day
• Flexibility: We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate
• Learning: All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders
• Development: We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like
• Recognition: We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers
• Office Location: A modern open plan workspace located in the bustling Back Bay neighborhood of Boston
• Additional Employer Paid Benefits: We offer employer-paid life insurance and short-term and long-term disability insurance