5 m r appeals coder jobs found

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com. Job Description: Job Description Function Asks: We are seeking dedicated and detail-oriented specialists who possess a coding certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials. The role...

Volumes: 1 domestic resources Key Responsibilities: Review and analyze medical records for Medicare appeals. Work on NCD/LCD denials, Duplicate denials, and MUE denials. Compare medical findings to CMS guidelines. Determine if conditions of coverage are met. Provide uphold justifications when conditions of coverage are not met. Maintain accurate and detailed documentation of all reviews and decisions. Communicate effectively with team members and other stakeholders. Stay updated with CMS guidelines and changes in Medicare policies. Initially focus on FACETS cases, with plans to expand to COSMOS cases. Handle additional coding-related scenarios as the team expands. Qualifications: Coding certificate (CPC, CCS, or equivalent). Strong understanding of medical records review. Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE). Experience with FACETS (primary). Experience with COSMOS (secondary). Excellent analytical and problem‑solving skills....

Louisville, KY, United States of America The Coder reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. This role is responsible for coding, charge entry, Accounts Receivable (A/R) follow-up and reimbursement management. This position also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. Essential Duties and Responsibilities Assigns and sequences codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the provider are valid and complete. Pulls all necessary information from health records to identify secondary complications and co-morbid conditions Abstracts all necessary information and assigns codes, which most accurately describe each documented diagnoses, procedure and special therapy according to established guidelines Determines the final...

RCS Medical Coding Auditor page is loaded## RCS Medical Coding Auditorremote type: Hybridlocations: Raleigh, NCtime type: Full timeposted on: Posted 7 Days Agojob requisition id: JR10360**Position Summary**The **RCS Medical Coding Auditor** is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback.The ideal candidate brings strong hands-on experience with **professional fee coding**, deep knowledge of **E/M, surgical, and modifier use**, and the ability to translate audit findings into actionable insights.**Key Responsibilities*** Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback* Validate ICD‐10‐CM, CPT(R), HCPCS, and modifier assignment against clinical documentation to...