Medical Coder (Edits & Denials)

Edit & Denials Coder

Required Skills & Experience- 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.

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.