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Certified Professional Coder

Naphcare

Job Location:

Birmingham, MI - USA

Monthly Salary: Not provided by the employer

Posted: 12 November 2026 (Yesterday)

Application Deadline: 9 February 2027

Vacancies: 1 Vacancy

Job Summary

Overview

NaphCare is hiring a Certified Professional Coderat our Corporate Offices in Birmingham AL.

The Certified Professional Coder is responsible for accurately assigning ICD-10-CM CPT and HCPCS codes including applicable modifiers for medical services provided in correctional healthcare facilities to support billing for eligible Medicaid pre-release (reentry) services. This role requires broad primary care or multi-specialty coding experience with the ability to code a high volume of encounters involving acute and chronic conditions behavioral health substance use disorder treatment medication management laboratory and radiology services DME and case management. The Coder will also ensure compliance with state-specific Medicaid demonstration requirements including covered-service guidelines and documentation standards.

Responsibilities

Review provider documentation and assign accurate ICD-10-CM CPT and HCPCS Level II codes and modifiers for outpatient professional encounters including evaluation and management (E/M) visits behavioral health minor procedures injections labs and point-of-care testing.
Maintain a close working relationship with departmental staff and query providers and clinical staff in a compliant manner when documentation is incomplete conflicting or does not support the level of service billed.
Work with billing team to resolve coding-related denials and rejections; identify trends and recommend corrective actions.
Maintain current knowledge of state Medicaid fee schedules billing manuals demonstration special terms and conditions National Correct Coding Initiative (NCCI) edits and medically unlikely edits (MUEs).
Participate in internal coding audits and maintain a coding accuracy rate of 95 percent.
Provide coding and documentation education to providers and nursing staff on E/M leveling diagnosis specificity and reentry documentation requirements.
Keep abreast of changes in coding guidelines regulations and technology.
Track annual and quarterly code set updates and state Medicaid policy changes and communicate changes to the team.
Support service-level tracking and reporting needed for state monitoring and reinvestment reconciliation.
Protect protected health information in accordance with HIPAA 42 CFR Part 2 (substance use disorder records) and NaphCare policy.
Perform other related duties as assigned.

Qualifications

Active unrestricted certification as a Certified Professional Coder (CPC) Certified Coding SpecialistPhysician-based (CCS-P) or Certified Coding Specialist (CCS) with documented professional-fee coding experience. CPC-A certification does not qualify.
Minimum of 3 years of recent professional-fee coding experience within the last 5 years including at least 2 years in an outpatient setting such as primary care family practice internal medicine urgent care FQHC RHC or a multi-specialty practice.
Demonstrated hands-on experience with Evaluation and Management (E/M) coding for new and established patients applying current AMA guidelines and medical decision-making criteria.
Experience coding Medicaid claims including familiarity with state-specific Medicaid billing requirements managed care and fee-for-service programs.
Strong working knowledge of ICD-10-CM CPT HCPCS modifiers NCCI edits MUEs and applicable coding and billing guidelines.
High school diploma or equivalent required with formal coding education covering medical terminology anatomy and physiology and pharmacology.
Proficiency with electronic health records (EHR) coding encoders practice management systems and Microsoft Excel with the ability to maintain productivity and accuracy standards in a high-volume environment.
Strong analytical communication and organizational skills with the ability to interpret Medicaid policies independently exercise sound judgment with confidential records and communicate effectively with providers nursing staff and billing teams.

Preferred Qualifications

Correctional healthcare behavioral health or substance use disorder coding experience including Medication-Assisted Treatment (MAT).
Experience with care coordination case management community health worker or peer support service coding.
Knowledge of Medicaid Section 1115 waivers justice-involved populations and applicable federal Medicaid requirements.
Additional coding or health information management credentials such as COC CRC CPMA or RHIT or an associate degree or higher in Health Information Management or a related field.
Experience conducting coding audits providing provider education or supporting coding compliance initiatives.

WORKING CONDITIONS MENTAL AND PHYSICAL DEMANDS

Ability to work and sit in front of a computer approximately 8 hours per day
Light physical work involving lifting bending and carrying up to twenty-five (25) pounds.
Talking and listening to communicate effectively with team members.
Visual acuity to perform an activity such as: preparing data/information and viewing a computer terminal
Ability to work under pressure

Reasonable Accommodation Statement

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.

Why Join NaphCare

NaphCare is one of the largest providers of healthcare services to correctional facilities throughout the US and we are growing. If you have never considered a career in correctional healthcare now may be the addition to competitive salaries and generous employee benefits we strongly support career advancement within the company.

NaphCare Benefits for Full-Time Employees Include:

Health dental & vision insurance that starts day one!
Prescriptions free of charge through our health plan beginning day one!
Lowest Cost Benefits!
Employee Assistance Program (EAP) services
401K and Roth with company contribution that starts day one!
Tuition Assistance
Referral bonuses
Term life insurance at no cost to the employee
Generous paid time off & paid holidays
Free continuing education and CMEs

If you would like to speak with me to learn more about this position and NaphCare apply directly to the position to initiate the application process and Ill be in touch.

Equal Opportunity Employer: disability/veteran

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Review provider documentation and assign accurate ICD-10-CM CPT and HCPCS Level II codes and modifiers for outpatient professional encounters including evaluation and management (E/M) visits behavioral health minor procedures injections labs and point-of-care testing.
Maintain a close working relationship with departmental staff and query providers and clinical staff in a compliant manner when documentation is incomplete conflicting or does not support the level of service billed.
Work with billing team to resolve coding-related denials and rejections; identify trends and recommend corrective actions.
Maintain current knowledge of state Medicaid fee schedules billing manuals demonstration special terms and conditions National Correct Coding Initiative (NCCI) edits and medically unlikely edits (MUEs).
Participate in internal coding audits and maintain a coding accuracy rate of 95 percent.
Provide coding and documentation education to providers and nursing staff on E/M leveling diagnosis specificity and reentry documentation requirements.
Keep abreast of changes in coding guidelines regulations and technology.
Track annual and quarterly code set updates and state Medicaid policy changes and communicate changes to the team.
Support service-level tracking and reporting needed for state monitoring and reinvestment reconciliation.
Protect protected health information in accordance with HIPAA 42 CFR Part 2 (substance use disorder records) and NaphCare policy.
Perform other related duties as assigned.

Active unrestricted certification as a Certified Professional Coder (CPC) Certified Coding SpecialistPhysician-based (CCS-P) or Certified Coding Specialist (CCS) with documented professional-fee coding experience. CPC-A certification does not qualify.
Minimum of 3 years of recent professional-fee coding experience within the last 5 years including at least 2 years in an outpatient setting such as primary care family practice internal medicine urgent care FQHC RHC or a multi-specialty practice.
Demonstrated hands-on experience with Evaluation and Management (E/M) coding for new and established patients applying current AMA guidelines and medical decision-making criteria.
Experience coding Medicaid claims including familiarity with state-specific Medicaid billing requirements managed care and fee-for-service programs.
Strong working knowledge of ICD-10-CM CPT HCPCS modifiers NCCI edits MUEs and applicable coding and billing guidelines.
High school diploma or equivalent required with formal coding education covering medical terminology anatomy and physiology and pharmacology.
Proficiency with electronic health records (EHR) coding encoders practice management systems and Microsoft Excel with the ability to maintain productivity and accuracy standards in a high-volume environment.
Strong analytical communication and organizational skills with the ability to interpret Medicaid policies independently exercise sound judgment with confidential records and communicate effectively with providers nursing staff and billing teams.