Coding Escalation Specialist, Pro Fee Hospital

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

📋 Description

• Address and resolve advanced coding issues escalated by coders, auditors, billing teams, and healthcare providers.

• Evaluate medical records and documentation to confirm accurate and compliant code assignments.

• Act as a subject matter expert (SME) regarding coding guidelines and payer-specific regulations.

• Detect coding trends, discrepancies, and compliance risks; propose corrective measures.

• Engage in coding audits and support the implementation of audit suggestions.

• Train and mentor coding staff on complex cases and updates to coding standards.

⛳️ Requirements

• A minimum of 3-5 years' experience in medical coding, focusing on complex case reviews or coding quality assurance.

• Certification from AAPC or AHIMA is mandatory.

• Possess expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems.

• Strong comprehension of CMS regulations and payer-specific guidelines.

• Exceptional analytical, problem-solving, and decision-making abilities.

• Familiarity with electronic health records (EHRs) and coding software systems.

🏝️ Benefits

• Ventra performance-based incentive plan.

• Referral bonus.