Coding Edits & Denials Specialist, AAPC or AHIMA Certification Required

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

📋 Description

• Deliver coding services to assist clients.

• Address ProFee and hospital outpatient/facility denials.

• Comprehend remit and CARC codes.

• Review and resolve denials using EPIC.

• Investigate payer policies.

• Identify recurring denial issues for escalation to management.

• Resolve Medical Necessity and CCI edits.

• Code surgical procedures typical of an ER environment to capture additional revenue when applicable.

• Apply ICD-10-CM diagnosis codes at the highest level of specificity available.

• Accurately apply ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS codes.

• Interpret coding guidelines for precise code assignment.

• Assess documentation and its impact on reimbursement.

• Adhere to AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct.

• Follow internal policies and procedures.

• Engage in company-provided training and education.

• Maintain a minimum of one AAPC or AHIMA credential.

• Safeguard confidential information and Personal Health Information.

• Execute other responsibilities as assigned by leadership.

⛳️ Requirements

• Permanent work status (USC/Greencard) is mandatory.

• Employees must live in and work within the continental U.S.

• Certification through either AAPC (CPC or COC) or AHIMA (CCS or CCS-P) is required.

• A minimum of 6 months of relevant on-the-job experience.

• Consistent, predictable, and punctual attendance is essential.

• Familiarity with systems such as EMR and Billing is necessary.

• Must have a telephone, reliable internet access, and current coding materials like CPT and ICD-10-CM coding references.

• Maintain an ongoing productivity level and accuracy rate of 95% or above.

• Proficient in Microsoft applications such as Excel and Outlook, including basic Excel formulas and managing Outlook emails and meetings.

• Capable of communicating effectively and professionally, both verbally and in writing.

• Ability to coordinate, analyze, observe, make decisions, and meet deadlines.

• Capability to work independently from home.

• Able to perform work at a computer terminal for 6–8 hours a day.

• Occasionally able to lift and move materials weighing up to 20 lbs.

🏝️ Benefits

• Quality of life with a predictable, full-time remote schedule.

• Competitive hourly rate based on experience.

• Comprehensive Medical, Dental, Vision coverage and more.

• Long-term disability insurance and life insurance provided.

• Generous parental leave policy.

• 401K plan with company matching.

• Certification and Tuition Reimbursement options.

• Holidays and paid time off.