Coder, Edit/Denials

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Analyzes the documentation in the records to pinpoint all relevant facts for appealing claims that have been denied by third-party payers or are on hold in host systems or billing clearinghouses.

• Composes appropriate letters to validate the legitimacy of claims.

• Collaborates with the facility liaison to examine documentation, resolve coding issues, and tag files for follow-up.

• Investigates and resolves reimbursement challenges in partnership with other coding staff and faculty.

• Works directly with the facility liaison or other clinical personnel as necessary to provide feedback on documentation and develop appeals.

• Researches payer policies and processes thoroughly.

• Evaluates clinical documentation in the medical record to determine all essential facts required to select comprehensive diagnoses and procedures that accurately reflect the patient's conditions and treatments.

• Manages assigned work queues and tasks and reviews remittance advice for rejections and payment accuracy as needed.

• Identifies invoices or claims that have been denied based on billing edits or criteria.

⛳️ Requirements

• Proficient knowledge of ICD-10 and CPT coding.

• Comfortable collaborating with accounts receivable teams to address issues.

• Capable of passing a coding assessment.

• Proficient in Microsoft Office Suite, including Outlook, Excel, and Teams.

• Exceptional ability to multi-task and exhibit excellent communication skills.

• Must achieve and maintain a 95% quality accuracy rate along with productivity standards.

• Ability to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics.

• Experience working in a remote setting is essential.

• Possession of CCS, AHIMA, CCS-P, CPC, AAPC, CPC-A, or AAPC credentials.

• A minimum of three years of coding experience is required.

🏝️ Benefits

• A reliable high-speed internet connection is mandatory for all remote or hybrid roles.

• A HIPAA-compliant work environment is provided.