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Claims Edit Coder Jobs in Tennessee (NOW HIRING)

Lyric

Executive Assistant

Nashville, TN

$40.87 - $61.31/hr

... claims workflows. Lyric augments human decision-making so health plans can make faster, more ... Prepare, edit and distribute presentation materials and documents * Acting on behalf of executive ...

Lyric

Executive Assistant

Nashville, TN · On-site

$40.87 - $61.31/hr

... claims workflows. Lyric augments human decision-making so health plans can make faster, more ... Prepare, edit and distribute presentation materials and documents * Acting on behalf of executive ...

All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Tennessee

Claims Edit Coder information

What is a claims edit coder?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What are the key skills and qualifications needed to thrive as a claims edit coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What are some common challenges faced by a claims edit coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are popular job titles related to Claims Edit Coder jobs in Tennessee?

For Claims Edit Coder jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Claims Edit Coder jobs in Tennessee look for?

The top searched job categories for Claims Edit Coder jobs in Tennessee are:

Claims Edit Coder jobs near you
Infographic showing various Claims Edit Coder job openings in Tennessee as of August 2026, with employment types broken down into 58% Full Time, and 42% Contract. Highlights an 100% Remote job distribution.

Medical Billing Specialist/Coder, Business Office, Downtown Nashville

HERITAGE MEDICAL ASSOCIATES P C

Nashville, TN • On-site

$18 - $23.25/hr

Full-time

Re-posted 7 days ago

Key responsibilities

  • Reviews daily charges from the electronic health record to ensure coding and billing guidelines are followed

  • Utilizes CPT, ICD-10CM, HCPCS coding, and modifiers during daily reviews and resolves complex billing scenarios

  • Researches front-end claim rejections, works with staff to resolve discrepancies, and ensures all charges are captured for month-end requirements

Job description

SUMMARY: The Charge Entry Specialist captures and reviews all billing codes prior to electronic claims filing, for accuracy and adherence to payer specific coding guidelines, for a multi-specialty physician group practice.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Reviews daily charges from the electronic health record to ensure coding and billing guidelines are followed
  • Utilizes CPT, ICD-10CM, and HCPCS coding and modifier usage during daily reviews
  • Utilizes various coding and billing references to resolve complex billing scenarios
  • Ensures progress notes are coded accurately and to the highest level of specificity
  • Maintains strong knowledge of payer billing guidelines and policies
  • Researches front-end claim rejections and works cooperatively with appropriate staff to resolve discrepancies
  • Timely alert any identified issues and/or risk that may require further research
  • Fulfill month end requirements ensuring all charges capture
  • Ability to meet deadlines and prioritize responsibilities

Secondary Responsibilities:
  • Maintains strong knowledge of both local and national CMS policies, as well as various private-payer coding and billing guidelines.
  • Utilizes the Correct Coding Initiative Edit List (CCI) when billing for multiple services during the same encounter and understands how to correctly apply Modifiers.
  • Informs Patient Accounts Department when additional account balance reviews are needed.
  • Researches front-end claim rejections and works cooperatively with appropriate staff to resolve discrepancies.
  • Utilizes various coding and billing references to resolve complex billing scenarios.
  • Consistently follows internal coding and billing protocols and policies.
  • Demonstrates a commitment to expand coding & billing knowledge by participating in various continuing education opportunities each year.
  • Demonstrates a positive willingness to take on additional assignments and responsibilities.
  • Must maintain professional and courteous relationships with all team members at all times.
  • Must have predictable and consistent attendance and follow all attendance policies.

Skills/Qualifications:
Active Certified Coder License CPD, CCS). Required experience in OB/GYN. Epic experience is desirable.
SUPERVISORY RESPONSIBILITIES
  • None

CERTIFICATES, LICENSES, AND REGISTRATIONS
  • Active Certified Coder License preferred (CPC, CCS)
    EDUCATION and/or EXPERIENCE
  • High school diploma required
  • OB/GYN Coding Experience Preferred
  • 5+ years of Charge Entry or Medical Billing experience required
  • Multi-Specialty physician coding experience preferred
  • Completion of an accredited Medical Coding/Billing Program preferred
  • Must have knowledge of CPT and ICD10
  • Experience with EPIC EMR System and Electronic Charge Capture preferred
    KNOWLEDGE, SKILLS, AND ABILITIES
  • Advanced knowledge of CPT, ICD-10CM, HCPCS coding and of Modifier usage for multiple specialties
  • Knowledge of CMS billing and documentation guidelines and CCI Edit Lists
  • Advanced understanding of medical documentation requirements for E/M coding and office procedures
  • Ability to abstract key information from the medical record to ensure accurate coding
  • Effective communication skills, to explain guidelines to new employees in an easy to understand manner
  • Excellent computer skills, including advanced typing speed, ten-key and mouse click selection skills
  • Ability to easily and quickly maneuver through various computer software programs such as MS Outlook, Word, Excel, electronic health records, patient billing systems, and other medical information software systems
  • Exceptional attention to detail and the ability to quickly identify discrepancies or uncommon billing situations
  • Strong judgment skills and ability to work through complex matters independently
  • Excellent time management and organizational skills
  • Ability to prioritize work responsibilities and complete assignments in a timely fashion
  • Strong initiative to anticipate departmental needs and work supportively to respond to such needs.
  • Ability to work effectively and cooperatively with all levels of management, physicians, team colleagues, and other departments.
    PHYSICAL DEMANDS
  • Must be able to sit for long periods of time
  • Requires moderate walking, bending, pushing, pulling, twisting and lifting
  • Mental alertness
    WORK ENVIRONMENT
  • High volume, faced paced office environment with a strong commitment to timeliness and organization
  • Office environment-limited exposure to communicable diseases.
  • No exposure to blood-borne pathogens or contaminated body fluids

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