Clinical Coding Expert
19 hours ago
Job Summary:
This medical coding specialist role is responsible for researching and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution. The solution is utilized by medical insurance payers across the United States.Key Responsibilities:- Conduct research on Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria.
- Provide written and oral presentations to medical directors (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.
- Offer clinical content support to customers as needed.
- Enter data into a database for clinical content updates, as required.
- Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
- A Bachelor's Degree in Nursing with an active RN license.
- Certification as an AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC), along with at least 5 years of experience in CPT Coding, HCPCS, Medical Billing, Claims Denials, and/or Chart Review/Auditing.
- Previous experience working with US health insurance payers in a claims, appeals, or coding capacity.
- Experience in denial management or claim review management is beneficial.
- Excellent communication skills (verbal and written) for effective interaction with all areas of the organization.
- Proficiency in using Microsoft Office applications.
- Ability to work night shifts.
This is a mid-to-senior level position that offers a full-time employment opportunity in a remote setting, allowing for flexible work arrangements including night shifts.
The ideal candidate will have a strong background in medical coding, excellent communication skills, and the ability to work effectively in a team environment.
We offer a competitive compensation package, comprehensive benefits, and opportunities for professional growth and development.
Seniority Level: Mid-Senior Level
Employment Type: Full-Time
Job Function: Healthcare Provider and Information Technology
Industries: Outsourcing and Offshoring Consulting
Location: Remote (Work From Home)
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