The HIRD- USA

A healthcare insurance company located in Atlanta, Georgia, seeks a coding specialist to review and analyze denied medical claims. Candidates must possess valid CPC or CCS certification and have extensive experience in the insurance industry. The responsibilities include conducting coding audits and ensuring compliance with reimbursement guidelines. This role requires excellent analytical skills and attention to detail for documenting audit findings and recommendations. #J-18808-Ljbffr

Responsibilities Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration. Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted. Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations. Coordinates research and responds to system inquiries and appeals. Conducts research of claims systems and system edits to identify...