Coding Specialist in Atlanta, Georgia at SOUTHSIDE MEDICAL CENTER

Position Summary:

Reports to the Chief Reports to the Chief Medical Officer. Performs medical coding assistance as required for Southside Medical Center, Inc. The Coding Specialist is responsible for accurate, compliant, and timely medical coding for services provided in a Federally Qualified Health Center (FQHC) setting. This role plays a critical role in reducing claim denials, supporting provider documentation, improving quality metrics, and ensuring optimal reimbursement while maintaining compliance with HRSA, CMS, OIG, and payer regulations. The Coding Specialist works closely with providers, billing, quality, and care management teams.

Position Description:

Assign accurate ICD-10-CM, CPT, HCPCS, and FQHC-specific codes for medical, behavioral health, dental, and enabling services as applicableApply correct FQHC billing methodologies (PPS, APG, or state-specific models) and encounter reporting requirementsPerform pre-bill and post-bill coding reviews to prevent denials, underpayments, and compliance riskReview provider documentation to ensure completeness, accuracy, and adherence to coding and documentation guidelinesIdentify documentation gaps and provide ongoing coding education, real-time feedback, and guidance to providersAnalyze coding-related denials and trends; recommend corrective actions and process improvementsSupport accurate diagnosis capture, risk adjustment, and HCC/RAF coding through compliant documentation reviewSupport coding and documentation for preventive services, chronic care management, and quality measures (UDS, HEDIS, and MCO pay-for-performance programs)Collaborate with billing and revenue cycle teams to resolve coding-related denials, edits, and payer inquiriesCollaborate with Quality Improvement, Care Management, and Clinical Operations teams to support performance on incentive-based measuresPerform coding audits and participate in internal and external compliance reviewsEnsure compliance with CMS, HRSA, OIG, NCCI, False Claims Act, and payer-specific regulationsStay current with annual code set updates, payer policies, and FQHC regulatory changesPrepare coding-related reports related to denial rates, coding accuracy, risk capture, and quality performanceMaintain productivity and accuracy standards as defined by the organizationProtect patient confidentiality in accordance with HIPAA regulations

Knowledge, Skills and Abilities:

Strong understanding of federal and state healthcare regulationsAbility to interpret complex coding, billing, and compliance guidelines Excellent written and verbal communication skillsAbility to work independently and manage multiple prioritiesTeam-oriented with a commitment to mission-driven healthcare and health equity

Minimum Qualifications:

High school diploma or equivalent (associate’s degree preferred)Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent requiredMinimum of 2 years of medical coding experienceExperience with ICD-10-CM, CPT, and HCPCS codingKnowledge of Medicare, Medicaid, and managed care payer rulesStrong attention to detail and analytical skillsProficiency with EHR and practice management systems

Preferred Qualifications:

Previous FQHC or community health center experienceKnowledge of PPS/APG billing and encounter-based reimbursementExperience with UDS reporting and HRSA complianceFamiliarity with behavioral health and/or dental codingExperience performing coding audits or provider education

Typical Physical Demands:

Prolonged periods of sitting and computer useAbility to maintain focus and accuracy for extended periodsMay require occasional travel for training or meetings (if applicable)

Southside is committed to providing Equal Employment Opportunity to each employee. Southside will not engage in unlawful discrimination against or harassment of any person employed by or seeking employment on the basis of race, color, religion, sex, sexual orientation, gender identity, ancestry, national origin, place of birth, age, marital status, veteran status, or any other characteristic protected by applicable federal, state or local law.