Certified Medical Coders

Job Type: Contract

Job Category: IT

Certified Medical Coders

Location: Remote (need to Travel in the Tampa Bay, FL or Atlanta Metro, GA)

Job Descriptions:-

Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.

Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.

Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.

Coordinates research and responds to system inquiries and appeals.

Conducts research of system edits and make determination on claim decision on the provider dispute.

Experience in working in various claims systems (i.e Facets, Encoder Pro, etc)

Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.

QUALIFICATIONS

Certified & active Professional Coder. AAPC (CPC, CEMC, COC, CIC) or AHIMA (CCS, CCS-P)

Experience with appeals and denials (NCD/LCD, Duplicate, MUE)

2 years of prior experience as a coder with E&M and surgical coding

Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.

Minimum 3 years’ experience reviewing denied claims and performing coding audits in a healthcare or insurance environment.

Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.

Ability to interpret medical records and apply coding principles accurately.

Facility coding experience preferred

Multiple specialty coding experience preferred experience in payor insurance processes

Experience in payor insurance processes preferred

Required Skills

CLOUD SECURITY ENGINEER

MEDICAL INSTRUMENTS

PRODUCT OWNER