Posted 6 days ago
We are seeking a certified professional coder with expertise in denial management to join our team. The ideal candidate will have 2-3 years of experience handling multi-specialty denials and possess a strong background in medical coding. This role requires an immediate joiner or candidates with a short notice period. The position involves detailed analysis of coding-related denials to identify root causes and implement corrective measures, ensuring accurate and timely resolution of denied claims.
Key Responsibilities:
- Analyze coding-related denials and conduct thorough root cause analysis (RCA).
- Validate ICD-10-CM, CPT/HCPCS, E/M levels, modifiers, bundling, diagnosis sequencing, and medical necessity coding.
- Compare denied claims against clinical documentation and applicable coding guidelines to determine necessary actions.
- Decide whether claims require coding corrections, reconsideration, or appeal support.
- Review National Correct Coding Initiative (NCCI) edits and payer-specific coding requirements.
- Identify recurring denial patterns and recommend corrective and preventive actions (CAPA).
- Provide coding feedback and educational support based on denial findings.
- Maintain accurate documentation of denials while adhering to quality standards and turnaround time (TAT) requirements.
- Verify accompanying Remark codes (RARC) and Explanation of Benefits (EOB) denial codes.
Required Qualifications:
- Certified professional coder credential from AAPC or AHIMA.
- Minimum 2-3 years of experience in medical coding, denial management, and claims review.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, E/M coding, and NCCI edits.
- Excellent analytical, problem-solving, and denial root cause analysis skills.
- Educational background as a life science graduate (postgraduate studies not required).
Preferred Qualifications:
- Additional certifications such as CPC, CCS, CCS-P, or COC are highly desirable.
- Experience working with multi-specialty denials and familiarity with payer-specific coding guidelines.
This role is designated as a Coder within the Medical Coding department, supporting Elevate Ent’s Data Marshall cost center. The position offers an opportunity to work in a dynamic environment focused on improving claim accuracy and reducing denials through expert coding and analysis. Candidates who can join immediately or with minimal notice will be given preference.
Job Details
Data Marshall
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