Medical Coder

Job Description

Job DescriptionJob Summary

We are a growing Arthritis and Rheumatology Center, seeking a highly experienced Lead Certified Medical Coder to support a compliance-driven rheumatology and infusion practice in Cumming, GA. This role is in-person and requires expert-level knowledge of rheumatology and biologic infusion coding, strict adherence to CMS and payer regulations, and active oversight of coding compliance through audits, monitoring, and corrective action. The Lead Coder serves as the primary coding authority and risk mitigation resource for the organization.

Key ResponsibilitiesCoding Compliance & Audit Oversight

• Ensure accurate and compliant coding of rheumatology services, biologic therapies, and infusion encounters

• Apply CPT, ICD-10-CM, HCPCS (including J-codes), modifiers, units, and wastage in strict accordance with CMS and payer guidelines

• Validate documentation supports medical necessity, infusion start/stop times, dosing, and administration requirements

• Conduct routine internal coding audits with documented findings and corrective actions

• Identify compliance risks, undercoding/overcoding trends, and audit vulnerabilities

• Prepare documentation and coding support for external audits and payer reviews

• Maintain audit logs, compliance reports, and corrective action plans

• Stay current on regulatory updates, NCCI edits, LCDs, NCDs, and payer infusion policies

Leadership & Team Governance

• Provide direct oversight of the coding team with accountability for compliance and accuracy

• Review coder output for audit readiness, consistency, and adherence to specialty standards

• Establish and enforce coding policies, workflows, and quality benchmarks

• Train and mentor coding staff on rheumatology- and infusion-specific compliance requirements

• Serve as escalation point for complex, high-risk, or audit-sensitive coding decisions

• Partner with compliance, billing, and A/R leadership to reduce regulatory risk and denials

Qualifications

• Active coding certification required (from AAPC)

• 3–5+ years of medical coding experience, with rheumatology and infusion coding required

• Demonstrated experience in audit-focused or compliance-driven environments

• Strong working knowledge of CMS regulations, payer policies, LCDs/NCDs, and infusion guidelines

• Prior experience in a lead, senior, or supervisory coding role preferred

• Advanced understanding of E/M guidelines, modifiers, NCCI edits, and drug billing rules

• Excellent analytical, documentation, and leadership skills

Benefits:

• Health Insurance
• Dental Insurance
• Vision Insurance
• 401K