Healthcare Medical Coder Employment Application

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Highest Level of Education Completed

Medical Coding Certifications (Select all that apply)

How many years of experience do you have as a medical coder?

List your previous employers relevant to medical coding (include employer name, position, and dates of employment):

Which coding systems are you proficient in? (Select all that apply)

Are you familiar with HIPAA regulations regarding medical records privacy?

When are you available to start?

Date

Upload your resume or CV

Signature (Please sign below to authorize your application)