Professional Coding Operations Specialist

Job Title: Specialist

Location: System Business Office

Department Name: HIM - Professional

Req #: 0000207744

Status: Salaried

Shift: Day

Pay Range: $56,797.00 - $80,225.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Job Summary:

The Professional Coding Operations Specialist supports the operational and quality functions of the professional fee coding program across RWJBH. Reporting to the System Professional Coding Operations and Talent Development Director, this role assists in monitoring outsourced coding productivity and quality, managing work queues, tracking unbilled accounts, and supporting education initiatives. The Specialist collaborates with internal coding and denials teams, vendor partners, and revenue cycle stakeholders to promote timely, accurate, and compliant coding practices.

This position requires strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems, as well as a working understanding of billing workflows, coding edits, and documentation requirements. The ideal candidate is detail-oriented, proactive, and committed to supporting high-quality coding operations across the enterprise.

Essential Functions:

• Monitors professional fee coding work queues and unbilled accounts to support timely claims submission and adherence to bill hold timelines.
• Tracks vendor coder productivity and quality metrics; escalates concerns to the Director as needed.
• Assists with medical record reviews to determine whether documentation supports the codes selected, ensuring accuracy and compliance with coding guidelines.
• Assists in preparing performance dashboards and summary reports for internal review.
• Supports the resolution of vendor coder inquiries by coordinating with internal teams and ensuring timely follow-up.
• Reviews coding-related edits (e.g., NCCI, modifier usage) and assists in identifying trends or recurring issues.
• Collaborates with the Denials Team to research and document root causes of coding-related denials.
• Participates in claim scrub activities to identify potential rejections or denials prior to billing.
• Assists in the development and delivery of coding education materials, including quarterly and annual updates.
• Maintains a centralized repository of coding references, including LCDs, NCDs, payer guidelines, and internal policies.
• Supports the implementation and maintenance of standardized coding policies and procedures.
• Communicates effectively with coding staff, vendors, and other departments to support operational goals.
• Performs other duties as assigned.

Job Requirements:

• CPC or COC certification required; credential must be maintained for continued employment.
• CPB or CPMA preferred.
• Associate's degree or equivalent experience required.
• Minimum 3 years of experience in coding and/or billing, including experience reviewing medical records for coding accuracy and addressing payer denials, and familiarity with revenue cycle processes.
• Denials management experience strongly preferred.
• Working knowledge of CPT, HCPCS, and ICD-10-CM coding systems.
• Familiarity with NCCI edits, modifier usage, and billing compliance guidelines.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) required.
• Experience with coding software platforms (e.g., 3M, EncoderPro, Epic) preferred.
• Strong organizational skills and attention to detail.
• Ability to manage multiple tasks, prioritize effectively, and meet deadlines.
• Excellent written and verbal communication skills.
• Some travel may be required for on-site support.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer