Medical Coder

• Review medical records and assign appropriate ICD-10-CM, CPT, and HCPCS codes based on documentation and services provided.
• Review and validate E/M coding and appropriate levels of service.
• Ensure coding accurately reflects diagnoses, conditions addressed, procedures performed, and services documented.
• Identify incomplete, conflicting, or insufficient documentation and communicate with providers when clarification is necessary.
• Review documentation for medical necessity and appropriate linkage between diagnoses and services.
• Apply current CMS, Louisiana Medicaid, NCCI, and payer-specific coding guidelines .
• Maintain knowledge of annual and interim coding and regulatory updates.

• Apply FQHC-specific billing and coding requirements, including qualifying visits, encounter coding, and applicable HCPCS codes.
• Understand the relationship between professional coding and FQHC Prospective Payment System (PPS) reimbursement.
• Review claims for appropriate FQHC billing methodology and payer-specific requirements.
• Understand differences among Medicare, Louisiana Medicaid, Medicaid Managed Care, and commercial payer requirements.
• Identify services that are separately billable, bundled, incidental, or included within the FQHC encounter payment.
• Maintain familiarity with coding requirements for primary care, preventive care, behavioral health, psychiatry, substance use disorder treatment, and other services provided by START Corporation.

• Perform pre-bill and post-bill coding reviews as assigned.
• Review coding-related claim edits, denials, and rejections and recommend appropriate corrections.
• Assist Revenue Cycle staff with coding-related appeals, reconsiderations, and payer disputes.
• Identify recurring coding, documentation, or payer issues affecting reimbursement.
• Assist with root-cause analysis of coding-related denials and underpayments.
• Identify opportunities to improve clean-claim rates and reduce avoidable denials.
• Collaborate with Billing, Revenue Cycle, HIM, Compliance, clinical leadership, and providers to resolve coding issues.

• Provide coding and documentation guidance to physicians, nurse practitioners, physician assistants, behavioral health professionals, and other clinical staff.
• Educate providers regarding documentation requirements necessary to support billed services.
• Communicate coding concerns professionally and provide supporting regulatory or coding guidance.
• Assist with internal coding audits and corrective-action initiatives.
• Participate in provider education regarding CPT, ICD-10-CM, HCPCS, CMS, Louisiana Medicaid, and payer changes.
• Identify potential compliance concerns and appropriately escalate findings.
• Maintain documentation supporting coding decisions and audit findings.

• Assist with accurate diagnosis coding related to risk adjustment and value-based care initiatives.
• Review documentation for appropriate capture of chronic conditions addressed during encounters.
• Support coding accuracy related to quality measures and preventive services.
• Collaborate with clinical and quality teams to improve documentation and coding accuracy while ensuring all reported diagnoses and services are supported by the medical record.

include: Medical, dental, and vision insurance; disability and life insurance; paid time off; 13 paid holidays per year for regular full-time employees; and a 403(b) retirement plan with employer matching.