Process Analyst - RCM Medical Coding

Role Summary

The Process Associate – RCM Medical Coding is responsible for accurate medical coding of clinical documentation to support precertification, billing, and reimbursement. Reporting to the Process Lead – RCM (Insurance, Coding & Precertification), this role ensures compliant coding aligned with payer and regulatory requirements to minimize denials and revenue leakage.

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Key Responsibilities

· Assign accurate CPT, ICD-10-CM/PCS, and HCPCS codes based on clinical documentation

· Validate coding accuracy for precertification, claims submission, and billing readiness

· Ensure compliance with CMS guidelines, payer rules, and NCCI edits

· Identify and correct coding errors that may lead to denials or delays

· Support coding-related denial analysis and appeals

· Participate in quality audits and address audit findings

· Collaborate with insurance, billing, AR, and CDI teams

· Escalate complex coding cases to the Process Lead

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Required Skills & Qualifications

· Bachelor’s degree or diploma in a healthcare-related field

· 3–5+ years of experience in US Healthcare Medical Coding

· Strong knowledge of CPT, ICD-10, and HCPCS

· Understanding of US healthcare RCM and payer requirements

· Experience with EHR/RCM systems (EPIC, 3M, Optum, Cerner, or similar)

· Strong attention to detail and ability to meet SLAs

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Certifications

· CPC, CCS, CCS-P, CIC, or equivalent – required / strongly preferred