Senior Medical Coder

Senior Medical Coding Specialist

About Triple

Triple is leading the way in remote work solutions, helping small and medium-sized businesses in North America build highly efficient remote teams for Administration, Customer Service, Accounting, Operations, and back-office roles. We focus on our Clients, People, and Planet, and we ensure our operations contribute positively across these key areas. Distinguished by its rigorous standards, Triple excels in:
Selectively recruiting the top 1% of industry professionals
Delivering in-depth training to ensure peak performance
Offering superior account management for seamless operations
Embrace unparalleled professionalism and efficiency with Triple, where we redefine the essence of remote hiring.

Position Title
Senior Medical Coding Specialist Remote (India)

Work Schedule
Monday to Friday
5:30 PM – 2:30 AM IST
Full-Time

Position Overview
Triple is seeking an experienced Medical Coding & Revenue Integrity Specialist to support our US healthcare clients by ensuring the highest standards of coding accuracy, compliance, and revenue optimization.
This role will serve as the coding subject matter expert (SME) within the Revenue Cycle Management (RCM) team, responsible for reviewing medical documentation, validating diagnosis and procedure codes, identifying coding discrepancies, conducting audits, and educating billing teams on coding best practices.
The ideal candidate possesses deep expertise in physician-office coding, Evaluation & Management (E&M) services, ICD-10-CM, CPT, HCPCS, modifier usage, and Medicare guidelines. Experience supporting Internal Medicine and Family Medicine practices is highly preferred.
This position plays a critical role in reducing coding-related denials, improving clean claim rates, strengthening compliance, and maximizing reimbursement for our healthcare clients.

Key Responsibilities
Coding Review & Validation
Review clinical documentation and validate ICD-10-CM, CPT, and HCPCS code selection.
Ensure diagnosis and procedure codes accurately reflect services documented by providers.
Verify coding accuracy prior to claim submission.
Identify under coding, over coding, unbundling, and unsupported coding practices.
Review documentation for medical necessity and payer compliance.
Ensure proper linkage between diagnosis codes and procedures.
Verify appropriate modifier assignment and usage.
E&M Coding Review
Evaluate office visit coding based on current E&M guidelines.
Review Medical Decision Making (MDM) components.
Validate time-based coding when applicable.
Identify opportunities to improve E&M coding accuracy.
Provide recommendations regarding documentation deficiencies impacting code selection.
Revenue Integrity & Audit Functions
Conduct routine coding audits across submitted and pending claims.
Perform retrospective and prospective coding reviews.
Identify coding trends resulting in denials or revenue leakage.
Analyze coding accuracy metrics and recommend corrective actions.
Prepare audit findings and present recommendations to leadership and client stakeholders.
Support denial management teams in resolving coding-related denials.
Compliance & Quality Assurance
Ensure adherence to CMS, Medicare, Medicaid, and commercial payer guidelines.
Maintain compliance with federal regulations and coding standards.
Monitor coding updates, annual CPT changes, ICD-10 updates, and payer-specific requirements.
Assist with internal and external audit preparation.
Support quality assurance initiatives across healthcare operations teams.
Training & Education
Develop and deliver coding training programs for billers and RCM staff.
Conduct refresher sessions on coding updates and compliance changes.
Coach billing teams on documentation requirements and coding best practices.
Create coding reference guides, SOPs, and educational materials.
Participate in onboarding and ongoing development of RCM team members.
Client Collaboration
Act as the coding SME for assigned healthcare clients.
Participate in client meetings as needed to discuss coding performance and audit findings.
Collaborate with providers, practice managers, billers, and account managers to improve coding workflows.
Support implementation of client-specific coding policies and procedures.

Required Qualifications
Minimum 3 years of experience in US Medical Coding.
Strong experience with physician-office coding.
Hands-on experience supporting Internal Medicine, Family Medicine, Primary Care, or Multi-Specialty practices.
Expert knowledge of:
ICD-10-CM
CPT
HCPCS
Evaluation & Management (E&M) Coding
Modifier Usage
Medicare Guidelines
Medical Necessity Requirements
Experience conducting coding audits and chart reviews.
Strong understanding of revenue cycle management processes.
Experience working with Electronic Health Records (EHR/EMR) systems.
Excellent analytical and problem-solving skills.
Strong written and verbal English communication skills.
Ability to work independently in a remote environment.

Preferred Qualifications
CPC (Certified Professional Coder) certification…