Posted 4 days ago

Coding Denials Auditor

FranklinRemoteFull-time

AI Summary

Reviews coded medical claims and records to verify coding accuracy, investigates denials, and drafts appeals using nationally recognized coding guidelines.

About this role

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

The Coding Denials Auditor provides analysis of coded medical services, reports, records, and billed charges, etc. to determine appropriateness of the medical coding utilized, delivery of care and treatment plans. The Coding Denials Auditor will use their expertise and coding expertise to communicate internally and externally.

Key Responsibilities

Conducts coding audits of submitted claims to determine appropriateness of procedure and diagnosis codes billed based on documentation provided for both outpatient facility and professional claims.

Reviews Billing for accuracy to ensure compliance of proper billing and coding procedures of third-party carriers and to ensure complete and accurate reimbursement.

Coordinates with revenue cycle teams to investigate rejected or denied claims to determine denial accuracy and work in an inter-departmental collaboration process to assist in claim corrections/appeals

Effectively utilizes computer and appropriate software (Microsoft Office Suite) to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment, including a basic to intermediate level of competency in Excel which is required

Maintains knowledge regarding medical coding and/or healthcare market changes.

Gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.

Draft appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, state fee schedule language, AAPC/AHIMA articles etc.

Other duties as required.

Requirements and Qualifications

Associates or Bachelor’s Degree

Current certification in one of the following: Certified Professional Coder (CPC) or related certification by AAPC, Certified Coding Associate (CCA) by AHIMA, Certified Coding Specialist (CCS) by AHIMA, Registered Health Information Technician (RHIT) by AHIMA.

The applicant must have a strong background in orthopedics and surgery billing/coding. The ideal candidate has 5+ years of experience in orthopedic surgery billing, a solid background in coding and medical billing, with special emphasis on AR, EOB's, and overall account management, including coding denials.

Must be able to gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.

Must have strong written communication skills. This position requires the ability to draft grammatically correct well written appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, state fee schedule language, AAPC/AHIMA articles etc.

Sound time management skills with the ability to manage workload independently

Strong analytical, problem solving and research skills with the ability to utilize creative thinking

Must be comfortable with CAC/Encoder audits and be able to identify appropriate code selection from audit findings.

Equivalent combination of education and experience will be considered.

Ability and skill set to work remotely.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions

Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).

Regular and predictable attendance.

Special Considerations and Prerequisites

Familiarity with healthcare documentation systems.

Experience with multiple fee schedule concepts such as DRGs, APCs, and NCCI.

Strong verbal, written and interpersonal communication and customer service skills.

Ability to communicate audit outcomes and testing results with other staff within the company who are both medically and non-medically oriented.

Ability to interpret policies and procedures and communicate complex topics to others.

Ability to think critically and make decisions within individual role and responsibility.

Complex Claims medical billing and coding experience strongly preferred.

Skills

AAPCAHIMAAPCsARCACCCACCSCPCCPT AssistantDRGsEncoderEOBExcelMicrosoft OfficeNCCIRHIT

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