New

Medical Coding Specialist

Spectraforce Technologies
United States, South Carolina, Columbia
Aug 19, 2025
Role Name: Medical Coding Specialist Location: Columbia, SC 29229 Work Environment: Onsite (Possibility to convert to remote after Onsite training) Schedule: Monday-Friday 8:30am - 4:30pm Contract length: 3 months assignment with possible conversion Job Summary: Duties/About the role: Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments. Day to Day: 60% Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation. 25% Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies. 10% Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff. 5% Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding Work environment: Typical office environment. Team Info: We have a team currently of 8 people that all work well together. We cover 4 projects for the year and are very successful at hitting targets and deadlines. The team is friendly and all willing to help and teach to make sure everything is done properly and in a timely manner. Any extra/additional job info: NA Job Requirements: Required Experience: 1+ years in medical coding or validation, specifically with ICD-9, DRG, APC, HIPPS, HCPCS, or RUG (or 2 years with 1 year clinical experience and 1 year in coding/validation) Required EDU: Associate's degree in Health Information Management, graduation from an accredited nursing school, or successful completion of AHIMA or AAPC certification exams. Required Certification or licenses: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) Required Software and Tools (Hands on experience required): Microsoft Office Soft skills: communication skills Nice to have/Preferred skills:2 years of medical coding experience. Languages: English