Coding Specialist

Job Description

Job Description

Position Summary :

Reports to the Chief Reports to the Chief Medical Officer. Performs medical coding assistance as required for Southside Medical Center, Inc. The Coding Specialist is responsible for accurate, compliant, and timely medical coding for services provided in a Federally Qualified Health Center (FQHC) setting. This role plays a critical role in reducing claim denials, supporting provider documentation, improving quality metrics, and ensuring optimal reimbursement while maintaining compliance with HRSA, CMS, OIG, and payer regulations. The Coding Specialist works closely with providers, billing, quality, and care management teams.

Position Description :

• Assign accurate ICD-10-CM, CPT, HCPCS, and FQHC-specific codes for medical, behavioral health, dental, and enabling services as applicable
• Apply correct FQHC billing methodologies (PPS, APG, or state-specific models) and encounter reporting requirements
• Perform pre-bill and post-bill coding reviews to prevent denials, underpayments, and compliance risk
• Review provider documentation to ensure completeness, accuracy, and adherence to coding and documentation guidelines
• Identify documentation gaps and provide ongoing coding education, real-time feedback, and guidance to providers
• Analyze coding-related denials and trends; recommend corrective actions and process improvements
• Support accurate diagnosis capture, risk adjustment, and HCC / RAF coding through compliant documentation review
• Support coding and documentation for preventive services, chronic care management, and quality measures (UDS, HEDIS, and MCO pay-for-performance programs)
• Collaborate with billing and revenue cycle teams to resolve coding-related denials, edits, and payer inquiries
• Collaborate with Quality Improvement, Care Management, and Clinical Operations teams to support performance on incentive-based measures
• Perform coding audits and participate in internal and external compliance reviews
• Ensure compliance with CMS, HRSA, OIG, NCCI, False Claims Act, and payer-specific regulations
• Stay current with annual code set updates, payer policies, and FQHC regulatory changes
• Prepare coding-related reports related to denial rates, coding accuracy, risk capture, and quality performance
• Maintain productivity and accuracy standards as defined by the organization
• Protect patient confidentiality in accordance with HIPAA regulations

Knowledge, Skills and Abilities :

Minimum Qualifications :

Preferred Qualifications :