Coding Denials Auditor
New
E
EnableCompHealthcare revenue cycle
United States - RemoteFull-TimeSenior
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- The ideal candidate has 5+ years of experience in orthopedic surgery billing
- Required Skills
- Microsoft ExcelMicrosoft Office
Requirements
- Associate’s or bachelor’s degree; an equivalent combination of education and experience will be considered.
- Current CPC certification or a related certification from AAPC, or CCA, CCS, or RHIT certification from AHIMA.
- Strong background in orthopedic and surgery billing/coding; 5+ years of orthopedic surgery billing experience is identified as ideal.
- Solid background in coding and medical billing, with emphasis on accounts receivable, EOBs, account management, and coding denials.
- Ability to gather and analyze claims and medical record information and make decisions based on documentation findings.
- Strong written communication skills and ability to draft grammatically correct, well-written payer appeals.
- Ability to use nationally sourced coding guidelines, including CPT Assistant, specialty societies, state fee schedule language, and AAPC/AHIMA articles.
- Time-management skills and ability to manage workload independently.
- Analytical, problem-solving, research, and critical-thinking skills.
- Comfort with CAC/Encoder audits and ability to identify appropriate code selection from audit findings.
- Strong computer proficiency, including MS Office applications such as Word, Excel, and Outlook; basic-to-intermediate Excel competency is required.
- Familiarity with healthcare documentation systems and fee schedule concepts such as DRGs, APCs, and NCCI.
Responsibilities
- Conduct coding audits of submitted outpatient facility and professional claims to assess procedure and diagnosis codes against documentation.
- Review billing for accuracy and compliance with third-party carrier billing and coding procedures.
- Coordinate with revenue cycle teams to investigate rejected or denied claims and support claim corrections and appeals.
- Gather and analyze claims and medical record information to assess documentation findings and outcomes.
- Draft payer appeals using nationally sourced coding guidelines, including CPT Assistant, specialty societies, state fee schedule language, and AAPC/AHIMA articles.
- Use Microsoft Office Suite, including Excel, to prepare correspondence, charts, spreadsheets, and other applicable information.
- Maintain knowledge of medical coding and healthcare market changes.
View Full Description & ApplyYou'll be redirected to the employer's site
