Medical Coder

Medical Coder

At Restore First Health, we are dedicated to providing advanced, in-home wound care through a holistic approach that emphasizes collaboration, communication, and care coordination. Our mission is to improve health outcomes by delivering innovative, patient-centered care. We are seeking a Medical Coder to provide support to our Revenue Cycle Management team. The Medical Coder is responsible for reviewing, analyzing, and accurately assigning medical codes to diagnoses, procedures, and services for telehealth, wound care, and acute care encounters in compliance with ICD-10-CM, CPT, HCPCS Level II, and payer-specific guidelines. This role ensures optimal reimbursement, supports compliance with federal and state regulations, and contributes to timely and accurate claim submission.

Key Responsibilities

Coding & Documentation Review

Assign accurate and complete ICD-10-CM, CPT, and HCPCS Level II codes for telehealth, wound care, and acute care services.

Review medical documentation for completeness and clarity, querying providers as needed for missing or ambiguous information.

Validate medical necessity and ensure codes align with payer-specific and CMS Local Coverage Determinations (LCDs), particularly for wound care procedures such as debridement and skin substitute application.

Apply correct telehealth modifiers (e.g., 95, FQ, FR) and place-of-service codes per CMS and commercial payer requirements.

Compliance & Quality Assurance

Maintain coding compliance with Medicare, Medicaid, and commercial payer guidelines.

Conduct regular self-audits to ensure accuracy and adherence to internal and external coding policies.

Support internal audits related to acute care, wound care, and telehealth encounters, providing education to providers and staff on documentation improvement opportunities.

Reimbursement & Revenue Cycle Support

Collaborate with the billing team to resolve coding-related claim rejections and denials.

Identify opportunities to improve revenue capture through accurate coding and documentation practices.

Assist in denial management by providing detailed coding rationales for appeals.

Communication & Education

Educate clinicians on documentation requirements to support accurate code assignment and reimbursement.

Communicate changes in coding guidelines, LCD updates, and payer policies related to telehealth, wound care, and acute care services.

Qualifications

A high school diploma or equivalent is required; an associate's or bachelor's degree in health information management is preferred.

Current certification from an accredited coding organization (e.g., CPC, COC, CIC, CCS, CCS-P).

Minimum 3-5 years of coding experience in a healthcare setting, preferably in wound care, acute care, and telehealth.

Strong knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines.

Familiarity with Medicare LCDs for wound care and telehealth regulations.

Proficiency with EMR / EHR systems and coding / billing software.

Strong analytical, organizational, and time-management skills.

Excellent verbal and written communication skills.

Ability to work independently and maintain strict confidentiality.

At Restore First Health, we are committed to work-life balance and a positive work environment that supports the well-being of every team member. We offer :

Paid holidays

Paid Time Off

401(k) with company match

Health, dental, and vision insurance options

And More!

Our Culture and Values : At Restore First Health, we believe that exceptional patient care starts with a strong, compassionate team. Our values emphasize :

Collaboration : Working closely with healthcare professionals, home health agencies, and skilled nursing facilities to ensure seamless wound care delivery.

Care Coordination : Partnering with physicians, specialists, and home care providers to optimize patient outcomes.

Communication : Prioritizing real-time updates and clear documentation to align all members of the care team.

By joining Restore First Health, you will be part of an innovative, patient-focused team dedicated to improving lives through advanced wound care.