RCM Coding Specialist

About the role

At ModMed , we are on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical-practic e success and improves patient outcomes. We live by our core values: Create Customer Delight and Save Time . Innovate Boldly , then make things happen. Align Passion with Purpose . Think Big. Have Fun. Do Good. The RCM Coding Specialist is a vital new role designed to make our team self-sufficient across the entire Revenue Cycle Management (RCM) cycle . This position serves as a Subject Matter Expert (SME), ensuring that medical coding is accurate, compliant, and optimized to reduce denials . You will bridge the gap between our global partners and US-based teams, providing the technical expertise necessary to improve patient outcomes and practice success .

Responsibilities

• Quality Assurance & Auditing (25%): Audit coding performed by Global Partners and provide timely feedback to resolve denied claims quickly .
• Denial Management (20%): Review and resolve coding denials from payers, ensuring accurate resubmission and revenue recovery .
• Subject Matter Expertise (20%): Act as the primary point of contact for coding questions and clarifications for the MMI team .
• Trend Analysis (15%): Review claims assigned to practices due to coding issues to identify trends; collaborate with Client Advisors (CAs) when practice education or intervention is needed .
• Preventive Strategy (10%): Analyze denial data to recommend preventive measures, such as scrub edits, provider training, and internal action plans .
• Continuous Learning (5%): Stay current with Payer Guidelines and participate in ongoing coding educational opportunities and webinars .
• Production Support (5%): Assist in production coding for various client specialties and scopes as needed .
• What You Bring
• Education & Certification: * Bachelor's or Master's degree in Human Science (Anatomy background), B.Sc, M.Sc, or B.Pharma .
• CPC (AAPC) or CCS (AHIMA) certification is highly preferred.
• Experience: * At least 5 years of overall experience in Provider RCM.
• A minimum of 2 years of core experience as a QA or SME within a Coding Department.
• Specialized Knowledge: * Expert-level knowledge in supplying, auditing, and analyzing CPT and ICD codes with appropriate modifiers.
• Proven ability to resolve coding-related denials and a deep understanding of payer guidelines.
• Strong coding knowledge in specialties including Gastroenterology, Orthopedics, Ophthalmology, Dermatology, and Podiatry .
• Skills: * Excellent written and verbal English communication skills.
• Ability to work independently and collaborate effectively across multiple countries.
• Strong analytical skills with proficiency in MS Excel for reporting and trend analysis.
• Why Join ModMed?
• You will be an integral part of a team that empowers medical practices to thrive. By ensuring coding accuracy, you directly contribute to our goal of saving time for doctors and improving the healthcare experience for patients.
• ModMed is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
• ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:
• Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
• Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family

Benefits

Additional Information

Join the Team Modernizing Medicine At ModMed , we're not just building software-we're reimagining the healthcare experience. Founded in 2010 by a practicing physician and a successful tech entrepreneur, we took a radically different approach: we hired doctors and taught them how to code. This "for doctors, by doctors" philosophy has allowed us to create an AI-enabled, specialty-specific cloud platform that places patients at the center of care. A Culture of Excellence When you join ModMed, you're joining an award-winning team recognized for innovation and employee satisfaction. From our global headquarters in Boca Raton Florida, and extensive employee base in Hyderabad India, we are a team of 4,500+ passionate problem-solvers on a mission to increase medical practice success and improve patient outcomes: Consistently ranked as a Top Place to Work 2025 Globee Business Awards: Gold Globee for "Technology Team of the Year" 2025 Black Book Awards: Ranked #1 EHR in 11 Specialties Florida Venture Forum: Venture-Backed Company of the Year We are growing fast, thinking big, and we are just getting started. Ready to modernize medicine with us? Job Description Summary: RCM Coding Specialist Location: Hyderabad Reports to: Sr. Manager, MMI (Administrative) | Manager, Medical

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