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Position Overview:

The RCM Coding Specialist is responsible for the accurate assignment of ICD-10-CM, CPT, and HCPCS codes based on clinical documentation to ensure compliant billing, timely claim submission, and optimal reimbursement. This role supports pre-claim workflows by identifying and resolving documentation gaps, validating medical necessity, and ensuring clean claim submission to reduce denials. The position collaborates cross-functionally with billing, AR, clinical, and operational teams to resolve coding and data deficiencies while maintaining compliance with payer guidelines and regulatory requirements. In addition to coding responsibilities, the role performs data analysis to identify trends, improve data quality, and drive revenue cycle performance. Success in this role requires strong attention to detail, deep coding expertise, and the ability to manage multiple priorities in a fast-paced environment. Performs other duties as assigned.

Job Roles & Responsibilities:

• Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS codes in compliance with coding guidelines • Validate medical necessity and ensure coding aligns with CMS, payer policies, and regulatory standards • Identify and resolve documentation deficiencies, including missing or invalid clinical data impacting claim submission • Support pre-claim workflows to ensure clean, accurate, and complete claims prior to billing • Analyze coding-related denials and perform re-coding or corrections as needed to support reimbursement • Collaborate with billing, AR, prior authorization, and clinical teams to resolve coding and documentation issues • Research claim and account information using internal systems, EMRs, and payer portals • Escalate complex coding or documentation issues to appropriate stakeholders • Monitor coding trends, identify performance gaps, and provide insights to improve quality and outcomes • Maintain accurate documentation and ensure compliance with HIPAA and PHI requirements Credence Resource Management v1.1 Effective – April 8, 2026 • Stay current with coding updates, payer requirements, and healthcare regulations • Support audits, quality reviews, and continuous improvement initiatives

Qualifications & Requirements:

Experience & Education

l 3–5+ years of experience in U.S. medical coding (laboratory experience preferred)

l Certified coder designation required (CPC, CCS, CCA, CIC or equivalent through AAPC or AHIMA)

l Healthcare-related degree or equivalent experience

Technical & Functional Expertise

l Strong knowledge of ICD-10-CM, CPT, HCPCS coding systems, modifiers, and NCCI edits

l Understanding of medical necessity requirements and payer-specific guidelines

l Knowledge of Medicare, Medicaid, and commercial payer regulations

l Experience with EMR/EHR systems, practice management systems, and payer portals

Skills & Competencies

l Strong attention to detail and high level of accuracy

l Analytical and problem-solving skills with ability to identify root causes and trends

l Ability to translate complex clinical and coding data into actionable insights

l Strong organizational skills with the ability to manage multiple priorities and deadlines

l Excellent verbal and written communication skills

l Ability to work independently and collaboratively across cross-functional teams

l Adaptability and ability to work in a fast-paced, evolving environment

l Commitment to maintaining confidentiality and compliance with HIPAA standards

Performance Expectations

l Ensure accurate and compliant coding to support clean claim submission and reduce denials

l Proactively identify and resolve documentation and coding gaps impacting reimbursement

l Meet or exceed productivity, accuracy, and turnaround time expectations

l Support continuous improvement initiatives to enhance coding quality and revenue outcomes

l Maintain compliance with all regulatory and organizational standards Key KPI’s

l Coding accuracy rate

l Coding-related denial rate

l First-pass clean claim rate

l Productivity and turnaround time

l Audit and compliance scores

Credence Global Solutions (“CGS”) is a Dallas, Texas based diversified technology driven financial transformation company with deep expertise in receivables management and voice based BPO. With focus on Receivables Management, Healthcare RCM, Technology Platforms and Contact Center verticals, CGS services leading telecommunication, healthcare, and media companies.

Healthcare providers serviced by CGS include medical transport providers, emergency physicians, health infusion service providers and diagnostic laboratories. In the telecommunication vertical, CGS serves four of the top five providers in United States.

Credence Resource Management is the flagship company of the Credence Group.

Our mantra is Excellence Beyond Belief. Challenges, growth opportunities and a passion for the Job enables us to repeatedly deliver excellence to our clients. Our teams are encouraged to continually explore their talents and pursue their interests, giving them the authority to gain knowledge and skills to truly be the expert in their domain. We strive to bring on the best and brightest, as well as to invest in their training and education, making them a seamless extension of your team.

Headquartered in Dallas TX, we have delivery offices in San Jose CA; Natchez MS; Mesa AZ & Pune India. Visit www.credencegs.com to know more about the company.