Position Summary:

The Professional Coding Quality & Revenue Recovery Coordinator supports accurate professional coding, compliant provider documentation, denial prevention, and revenue recovery across hospital-based and outpatient clinical services. This role evaluates coding and reimbursement issues, provides education to coding staff and providers, and develops strategies to address documentation deficiencies, payer requirements, and preventable denials. The Coordinator collaborates across coding, billing, clinical, and payer teams to strengthen coding quality, regulatory compliance, reimbursement integrity, and the overall encounter-to-billing process.

Key Responsibilities:

• Provide professional coding education and quality guidance to coding staff and providers regarding CPT, HCPCS, ICD-10-CM, evaluation and management coding, NCCI edits, documentation standards, payer requirements, and applicable regulatory updates.
• Perform coding and documentation quality reviews to identify accuracy, compliance, reimbursement, and workflow risks, and develop targeted education and corrective actions based on identified findings.
• Analyze denial, write-off, audit, and reimbursement trends to identify root causes and recommend improvements to documentation, coding, billing, and revenue cycle processes.
• Investigate complex coding and reimbursement denials, prepare well-supported appeals, and coordinate appropriate escalation through payer reconsideration and applicable external review processes.
• Collaborate with physicians, advanced practice providers, coding teams, billing teams, patient representatives, and payers to resolve documentation and reimbursement discrepancies using approved communication and query processes.
• Develop specialty-specific coding resources and communicate emerging coding trends, payer policy changes, denial patterns, and reimbursement risks to support consistent practices and prevent recurring issues.

Licenses and Certifications Required:

• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician-based (CCS-P); and
• Certified Professional Medical Auditor (CPMA) or Certified Evaluation and Management Coder (CEMC).

Educational Requirements:

• Bachelor's degree in health information management, Healthcare Administration, Business Administration, or a related field preferred.

Experience Requirements:

• Minimum of five years of experience in professional medical coding, coding quality auditing, revenue recovery, insurance appeals, or denial management.
• Experience using electronic health record (EHR) and professional billing systems such as Cerner, Allscripts, Epic Resolute, or comparable platforms.

Special Skills or Training Requirements:

• Demonstrated knowledge of ICD-10-CM, CPT, HCPCS, E/M guidelines, NCCI edits, payer reimbursement policies, and regulatory compliance requirements.
• Strong analytical, critical thinking, communication, problem-solving, and relationship-building skills with the ability to collaborate effectively across clinical and operational teams.

Physical Requirements:

The Professional Coding Quality & Revenue Recovery Coordinator primarily performs work requiring prolonged sitting, computer use, keyboarding, reading, and review of detailed electronic documentation. The role requires occasional standing, walking, reaching, and handling or moving light office materials and supplies. Adequate vision, hearing, manual dexterity, and verbal and written communication abilities are required to review coding information, use electronic systems, and communicate effectively with clinical and operational stakeholders.

Environmental Requirements:

The Professional Coding Quality & Revenue Recovery Coordinator works primarily in a professional office or remote work environment with extensive use of computers, electronic health records, professional billing applications, and communication systems. The role may involve competing deadlines, complex reimbursement matters, high-volume workloads, and interaction with clinical and operational departments across multiple locations. The Coordinator must follow organizational privacy, information security, safety, and infection-prevention requirements when working with protected health information or when present in clinical facilities.