Lead Certified Professional Coder at CLS Health PLLC

Webster, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Jan, 26

Salary

0.0

Posted On

15 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

CPC Certification, CPT Coding, ICD-10 Coding, HCPCS Coding, Coding Audits, Documentation Review, Education, Claim Workflows, Denial Management, Appeal Processes, CMS Regulations, Payer Policies, Clinical Documentation Standards, Attention To Detail, Communication Skills, Collaboration Skills

Industry

Hospitals and Health Care

Description

Description About CLS Health: At CLS Health, we are redefining healthcare delivery. As Houston’s largest physician-owned, physician-led healthcare system, our mission is to provide patient-centered care through innovation and operational excellence. With over 200 providers in 35+ locations and over 50 specialties, we’re building a scalable healthcare system that empowers physicians and delivers unmatched quality and access for patients. We are Looking for: We are seeking a highly experienced and detail-oriented Lead Certified Professional Coder to help shape and optimize our coding workflows and compliance standards. This role plays a key leadership position in designing rules, audits, and education logic that directly support claim accuracy, reduce denials, and ensure payer and CMS compliance across multiple specialties. Key Responsibilities: Define coding logic and business rules for: Claim Holds, Edits, and Denials Appeal types and resolution pathways Develop audit and education frameworks to ensure provider documentation meets requirements for CPT, ICD-10, and HCPCS coding. Collaborate with the Compliance Officer to maintain up-to-date adherence with CMS guidelines and payer-specific rules. Create and maintain clinical-to-coding mappings, workflows, and coding pathways for multi-specialty environments. Assist in the development of tools and systems (e.g., Coder+) that support coding workflow automation. Participate in coder education, documentation improvement efforts, and coding policy development. Stay current with changes in federal regulations, payer guidelines, and specialty-specific coding updates. Why You’ll Love Working With Us: Competitive salary Supportive team culture Real opportunities for professional development and career growth Full benefits package including: 401(k) with company match Medical, Dental, Vision, and Life Insurance Paid time off Disability insurance Requirements CPC (Certified Professional Coder) or COC (Certified Outpatient Coder) certification required. 5–10 years of coding experience, preferably in a multi-specialty or ambulatory care setting. Deep understanding of CPT, ICD-10-CM, HCPCS Level II coding systems, and medical terminology. Experience in coding audits, documentation review, and education. Familiarity with claim workflows, denial management, and appeal processes. Strong knowledge of CMS regulations, payer policies, and clinical documentation standards. Excellent attention to detail and ability to interpret complex medical and billing documentation. Strong communication and collaboration skills to work with compliance, product, and clinical teams. Preferred Qualifications: Experience with EHR and RCM platforms (e.g., Epic, athenahealth, eClinicalWorks). Exposure to coding automation platforms or rule-based engines. Prior leadership or mentorship experience in coding teams.

Responsibilities

The Lead Certified Professional Coder will define coding logic and business rules, develop audit frameworks, and collaborate with compliance to ensure adherence to guidelines. This role is crucial for optimizing coding workflows and ensuring claim accuracy across multiple specialties.