Coding Denials Auditor

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

📋 Description

• Perform coding audits for submitted outpatient facility and professional claims.

• Assess billing accuracy and ensure compliance with billing and coding procedures set by third-party carriers.

• Collaborate with revenue cycle teams to investigate claims that have been rejected or denied.

• Support claim corrections and appeals through inter-departmental cooperation.

• Utilize Microsoft Office Suite to create correspondence, charts, spreadsheets, and other related documents.

• Stay updated on medical coding practices and changes in the healthcare market.

• Collect and analyze claims and medical records information to evaluate documentation findings and outcomes.

• Prepare payer appeals based on nationally established coding guidelines.

• Convey coding expertise and audit results to internal and external stakeholders.

• Execute additional duties as assigned.

⛳️ Requirements

• Associate's or Bachelor's Degree required.

• Active certification: CPC, AAPC-related certification, CCA, CCS, or RHIT.

• Comprehensive knowledge in orthopedics and surgery billing/coding.

• Preferred candidate should possess over 5 years of experience in orthopedic surgery billing.

• Experience in coding and medical billing, including accounts receivable, explanation of benefits, account management, and coding denials.

• Proficient in gathering and analyzing claims and medical records information.

• Excellent written communication skills.

• Capability to draft grammatically correct appeals utilizing CPT Assistant, guidance from specialty societies, state fee schedules, and AAPC/AHIMA publications.

• Strong time management skills with the ability to manage workload independently.

• Exceptional analytical, problem-solving, research, and creative-thinking abilities.

• Comfortable with CAC/Encoder audits and selecting appropriate codes.

• Equivalent combination of education and experience will be considered.

• Ability to work remotely.

• High proficiency in computer skills, including Microsoft Word, Excel, and Outlook.

• Consistent and predictable attendance is required.

• Familiarity with healthcare documentation systems is a plus.

• Experience with DRGs, APCs, and NCCI fee schedule concepts.

• Excellent verbal, written, interpersonal communication, and customer service skills.

• Ability to communicate audit results and testing outcomes to both medically and non-medically oriented staff.

• Skill in interpreting policies and procedures and conveying complex topics effectively.

• Ability to think critically and make decisions within the scope of responsibilities.

• Experience in complex claims medical billing and coding is highly preferred.

🏝️ Benefits

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• Flexible and family-oriented work culture.

• Support for work-life balance.

• Option for remote work.