Medical Coder (Edits & Denials)

Job Description

We are seeking an Edit & Denials Coder to review medical records to determine appropriate billing codes and necessary documentation. This role is responsible for performing advanced coding and appeal activities; investigating payer issues, completing charge corrections, and for timely filing of appeals to insurance companies.

Key Responsibilities: • Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse. Creates appropriate letters to substantiate the validity of claims. • Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up. Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty. Works directly with facility liaison or other clinical staff as needed to provide documentation feedback and to develop appeals. • Researches payer policies and processes. • Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment. • Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed. Identifies invoices or claims that have been rejected per billing edits/criteria.

Skills and Requirements

• 5+ years of Edit & Denials coding
• Active AAPC or AHIMA credential
• Ability to independently resolve denials.
• Strong payer knowledge
• Knowledge of ICD-10 and CPT Coding
• Must be comfortable working with AR teams to resolve issues.
• Must be able to pass a coding assessment.
• Must be proficient in Microsoft Office, including Outlook, Excel, and Teams.
• Ability to multi-task and have excellent communication skills.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.