Lead Certified Professional Coder

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.