Certified Professional Coder

Overview

NaphCare is hiring a Certified Professional Coder at our Corporate Offices in Birmingham, AL. The Certified Professional Coder is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes, including applicable modifiers, for medical services provided in correctional healthcare facilities to support billing for eligible Medicaid pre-release (reentry) services. This role requires broad primary care or multi-specialty coding experience, with the ability to code a high volume of encounters involving acute and chronic conditions, behavioral health, substance use disorder treatment, medication management, laboratory and radiology services, DME, and case management. The Coder will also ensure compliance with state-specific Medicaid demonstration requirements, including covered-service guidelines and documentation standards.

Responsibilities

• Review provider documentation and assign accurate ICD-10-CM, CPT, and HCPCS Level II codes and modifiers for outpatient professional encounters, including evaluation and management (E/M) visits, behavioral health, minor procedures, injections, labs, and point-of-care testing.
• Maintain a close working relationship with departmental staff and query providers and clinical staff, in a compliant manner, when documentation is incomplete, conflicting, or does not support the level of service billed.
• Work with billing team to resolve coding-related denials and rejections; identify trends and recommend corrective actions.
• Maintain current knowledge of state Medicaid fee schedules, billing manuals, demonstration special terms and conditions, National Correct Coding Initiative (NCCI) edits, and medically unlikely edits (MUEs).
• Participate in internal coding audits and maintain a coding accuracy rate of 95 percent.
• Provide coding and documentation education to providers and nursing staff on E/M leveling, diagnosis specificity, and reentry documentation requirements.
• Keep abreast of changes in coding guidelines, regulations, and technology.
• Track annual and quarterly code set updates and state Medicaid policy changes, and communicate changes to the team.
• Support service-level tracking and reporting needed for state monitoring and reinvestment reconciliation.
• Protect protected health information in accordance with HIPAA, 42 CFR Part 2 (substance use disorder records), and NaphCare policy.
• Perform other related duties as assigned.

Qualifications

• Active, unrestricted certification as a Certified Professional Coder (CPC), Certified Coding Specialist–Physician-based (CCS-P), or Certified Coding Specialist (CCS) with documented professional-fee coding experience. CPC-A certification does not qualify.
• Minimum of 3 years of recent professional-fee coding experience within the last 5 years, including at least 2 years in an outpatient setting such as primary care, family practice, internal medicine, urgent care, FQHC, RHC, or a multi-specialty practice.
• Demonstrated hands-on experience with Evaluation and Management (E/M) coding for new and established patients, applying current AMA guidelines and medical decision-making criteria.
• Experience coding Medicaid claims, including familiarity with state-specific Medicaid billing requirements, managed care, and fee-for-service programs.
• Strong working knowledge of ICD-10-CM, CPT, HCPCS, modifiers, NCCI edits, MUEs, and applicable coding and billing guidelines.
• High school diploma or equivalent required, with formal coding education covering medical terminology, anatomy and physiology, and pharmacology.
• Proficiency with electronic health records (EHR), coding encoders, practice management systems, and Microsoft Excel, with the ability to maintain productivity and accuracy standards in a high-volume environment.
• Strong analytical, communication, and organizational skills, with the ability to interpret Medicaid policies independently, exercise sound judgment with confidential records, and communicate effectively with providers, nursing staff, and billing teams.

Preferred Qualifications

• Correctional healthcare, behavioral health, or substance use disorder coding experience, including Medication-Assisted Treatment (MAT).
• Experience with care coordination, case management, community health worker, or peer support service coding.
• Knowledge of Medicaid Section 1115 waivers, justice-involved populations, and applicable federal Medicaid requirements.
• Additional coding or health information management credentials, such as COC, CRC, CPMA, or RHIT, or an associate degree or higher in Health Information Management or a related field.
• Experience conducting coding audits, providing provider education, or supporting coding compliance initiatives.