Medical Coding Denials Specialist

Summary

Join our team as a remote contracted medical coding denials specialist! This role requires at least 5 years of professional surgical coding experience and 3 years of denial management experience. You will review and analyze coding denials, identify root causes, prepare appeal letters, and conduct audits. A strong understanding of ICD-10, CPT, and HCPCS guidelines is essential. The ideal candidate is resourceful, organized, independent, and driven. This is a remote position.

Requirements

• High school diploma or equivalent
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or equivalent coding certification
• Minimum of 5 years of experience in medical coding
• Minimum of 3 years denial management experience
• Strong understanding of ICD-10, CPT, HCPCS coding systems, and payer-specific guidelines
• Knowledge of medical terminology, healthcare billing processes, and insurance claim adjudication
• Excellent analytical and problem-solving skills
• Effective written and verbal communication skills for interacting with healthcare providers, payers, and team members
• Proficiency with healthcare billing software, electronic medical records (EMR), and Microsoft Office Suite
• Ability to multitask and keep a sense of urgency
• Strong time management, organization skills, and work ethic
• Ability to work independently

Responsibilities

• Review and analyze coding related denials and rejections from insurance payers
• Identify root causes of denials, such as incorrect coding, missing information, or insufficient documentation
• Prepare appeal letters to insurance companies, ensuring accurate, compliant, and complete responses to denials
• Conduct thorough audits of medical records and claims to ensure accurate coding in compliance with ICD-10, CPT, and HCPCS guidelines
• Identify trends in coding denials
• Follow current ICD-10 and CPT coding guidelines
• Adhere to NCD, LCD, and CCI policies as necessary
• Apply modifiers as appropriate
• Stay updated about new coding rules as codes routinely change
• Responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach
• Requires long periods of time sitting and using keyboard and mouse
• Meet and maintain department production and quality standards
• Additional tasks/duties as assigned by management

Preferred Qualifications

Associate or Bachelor’s degree in Health Information Management, Medical Billing and Coding, or a related field