Job Description
Job Description
The Certified Medical Coder is responsible for accurate, compliant, and timely coding of professional and facility pain management services, with a strong emphasis on Workers’ Compensation and Functional Rehabilitation Programs (FRP). This role supports interventional pain evaluation and management, rehabilitation services, and ancillary procedures, while ensuring compliance with state-specific WC rules, payer-specific billing guidelines, and other payer requirements. Performs review of all coding related holds for Boomerang Health Care (BHC) to ensure consistency in documentation needed to meet compliance guidelines for appropriate and effective reimbursement.
*This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA.
What you will do:
- Assign accurate CPT, HCPCS, and ICD-10 codes for all services performed at BHC facilities.
- Apply appropriate modifier usage based on payer and service requirements.
- Ensure documentation supports medical necessity, procedural complexity, and level of services.
- Apply correct diagnosis sequencing and body-part specificity required for WC claims.
- Support WC-specific documentation requirements, including injury dates. Causality, and treating physician narratives.
- Collaborate with billing teams to ensure correct claim formats, attachments, and WC payer rules are met.
- Ensure coding compliance with CMS, AMA, NCCI, and OIG guidelines
- Participate in internal and external coding audits, implement corrective actions as needed.
- Identify coding trends that impact denials, underpayments, or compliance risk
- Provide feedback and education to provider to improve documentation and coding accuracy.
- Assumes other responsibilities as appropriate to the position and organizational needs
Qualifications:
- High school diploma or equivalent required; Associate degree preferred
- Active coding certification required: CPC, CCS, or equivalent (AAPC or AHIMA)
- Minimum 3-5 years of medical coding experience in pain management, workers’ compensation billing.
- Demonstrated experience with FRP or multidisciplinary rehab models as well as Commercial and Medicare pain management coding.
- Ability to work in a fast-paced environment, meet daily deadlines, and collaborate with cross-functional RCM teams