Medical Coder, Pre-Claims

Responsible for ensuring coding accuracy and claim readiness prior to submission, with a focus on resolving missing or invalid order and documentation elements that can drive rejections, denials, and delayed reimbursement. Partners closely with front-end revenue cycle teams and the broader RCM organization to strengthen clinical defensibility and coding integrity through standardized workflows, proactive quality reviews, and documentation readiness.

Role impact

• Strengthens pre-claim coding and documentation integrity to reduce avoidable rework and improve reimbursement outcomes.
• Supports patients, providers, Client Services, Market Access partners, and Revenue Cycle operations through improved claim quality and fewer downstream delays.
• Helps improve front-end completeness, clean-claim readiness, and reduce coding- or documentation-related denials.

Key responsibilities

• Review orders and supporting documentation to confirm accurate, compliant ICD-10 and CPT/HCPCS coding inputs needed for clean claim submission.
• Identify missing or incomplete claim-critical elements such as ICD-10 codes, patient demographics, insurance details, and medical-necessity documentation, and drive timely remediation through established workflows.
• Confirm that documentation and coding elements required to meet payer expectations are in place prior to claim submission, escalating gaps for resolution as needed.
• Execute coding-focused quality checks and proactive audits to detect trends, prevent repeat errors, and reduce downstream denials tied to documentation or coding gaps.
• Contribute to standardized templates and checklists that improve pre-claim readiness.
• Partner with front-end operations, prior authorization workflows, and demographic accuracy processes to reduce missing billing information and rework.
• Collaborate cross-functionally to translate payer requirements into scalable operational practices that support clean claims and consistent outcomes.
• Track and communicate recurring gap themes that impact clean claims and downstream adjudication.
• Support key operational metrics such as Missing Billing % and Clean Claim Rate.
• Perform other related duties in support of RCM operational objectives.