Medical Coder Pre Claims

The

Medical Coder, RCM

is responsible for ensuring coding accuracy and claim readiness prior to submission, with a focus on resolving missing or invalid order and documentation elements that drive rejections, denials, and delayed reimbursement. This role partners closely with RCM front-end teams and the broader RCM organization to strengthen clinical defensibility and coding integrity through standardized workflows, proactive quality reviews, and documentation readiness.

What this role exists to do

• Strengthen pre-claim coding and documentation integrity to reduce avoidable rework and improve reimbursement outcomes.

Who it impacts

• Patients, providers, Client Services, Market Access partners, and Revenue Cycle operations benefit from improved claim quality and fewer downstream delays.

What success looks like

• Improved front-end completeness (e.g., fewer missing ICD-10, demographic, or insurance elements), improved clean-claim readiness, and fewer coding- or documentation-related denials.

KEY RESPONSIBILITIES

1) Pre‑Claim Coding \& Documentation Readiness

• Review orders and supporting documentation to confirm accurate, compliant ICD-10 and CPT/HCPCS coding inputs needed for clean claim submission.
• Identify missing or incomplete claim-critical elements (e.g., ICD-10 codes, patient demographics, insurance details, medical-necessity documentation) and drive timely remediation through established workflows.
• Confirm that documentation and coding elements required to meet payer expectations are in place prior to claim submission, escalating gaps for resolution as needed.

2) Quality Controls, Proactive Audits \& Standardization

• Execute coding-focused quality checks and proactive audits to detect trends, prevent repeat errors, and reduce downstream denials tied to documentation or coding gaps.
• Contribute to the creation and maintenance of standardized templates and checklists that improve pre-claim readiness (e.g., documentation requirements, coding-integrity checks).

3) Cross‑Functional Partnership (Front End RCM \+ Clinical Ops \& Coding)

• Partner with front-end operations (eligibility/benefits investigation, prior-authorization workflows, and demographic-accuracy processes) to reduce missing billing information and rework before claims are submitted.
• Collaborate cross-functionally to translate payer requirements into scalable operational practices that support clean claims and consistent outcomes.

4) Operational Reporting \& Performance Support

• Support visibility into pre-claim performance drivers by tracking and communicating recurring gap themes that impact clean claims and downstream adjudication.
• Align work to key operational metrics used to manage RCM performance (e.g., Missing Billing %, Clean Claim Rate) to reduce bottlenecks before they affect revenue.

5) Other

• Perform other job-related duties as assigned in support of RCM operational objectives.

QUALIFICATIONS

Required

• High school diploma or equivalent; additional education in health sciences or a related field preferred.
• Demonstrated working knowledge of ICD-10-CM and CPT/HCPCS coding concepts as applied to claim-submission readiness.
• Proven ability to identify missing or invalid claim-critical data elements and drive resolution through cross-functional coordination.

Preferred

• Professional coding certification (AAPC/AHIMA or equivalent).
• Experience supporting pre‑claim quality, audits, or denial prevention workflows in a high-volume healthcare revenue cycle environment.

COMPETENCIES (3-5)

• Coding Integrity \& Compliance Mindset
• Attention to Detail / Pre-Claim Quality Focus
• Analytical Problem Solving (data gaps, root-cause trends)
• Cross-Functional Execution \& Follow-Through
• Clear Communication (documentation gaps, remediation guidance)

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Frequently required to sit and work at a computer for extended periods.
• Frequently required to use hand and finger dexterity for typing and data entry.
• Work environment: Onsite, hybrid, or remote.

EEO Statement

Baylor Genetics is proud to be an equal opportunity employer dedicated to building an inclusive and diverse workforce. We do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, gender identity, veteran status, disability, genetic information, pregnancy, childbirth, or related medical conditions, or any other status protected under applicable federal, state, or local law.

Note to Recruiters:

We value building direct relationships with our candidates and prefer to manage our hiring process internally. While we occasionally partner with select recruitment agencies for specialized roles, we do not accept unsolicited resumes from recruiters or agencies without a written agreement executed by the authorized signatory for Baylor Genetics ("Agreement"). Any resumes submitted to Baylor Genetics in the absence of an Agreement executed by Baylor Genetics' authorized signatory, will be considered the property of Baylor Genetics, and Baylor Genetics will not be obligated to pay any associated recruitment fees.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.