Diverse Lynx
Tampa, FL, USA
Current Coding certificate AAPC (CPC, CEMC, COC, CIC) or AHIMA (CCS, CCS-P) 3+ Years working in the health insurance field. Evaluation and Management (E&M) & GMC Coding - MUST have 3+years of experience 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...