Coding Denials Auditor

Job Description:

• Conduct coding audits of submitted outpatient facility and professional claims
• Review billing accuracy and compliance with third-party carrier billing and coding procedures
• Coordinate with revenue cycle teams to investigate rejected or denied claims
• Assist with claim corrections and appeals through inter-departmental collaboration
• Use Microsoft Office Suite to produce correspondence, charts, spreadsheets, and related information
• Maintain knowledge of medical coding and healthcare market changes
• Gather and analyze claims and medical records information to assess documentation findings and outcomes
• Draft payer appeals using nationally sourced coding guidelines
• Communicate coding expertise and audit outcomes internally and externally
• Perform other duties as required

Requirements:

• Associate's or Bachelor's Degree
• Current certification: CPC, AAPC-related certification, CCA, CCS, or RHIT
• Strong background in orthopedics and surgery billing/coding
• Ideal candidate has 5+ years of orthopedic surgery billing experience
• Background in coding and medical billing, including AR, EOBs, account management, and coding denials
• Ability to gather and analyze claims and medical records information
• Strong written communication skills
• Ability to draft grammatically correct appeals using CPT Assistant, specialty society guidance, state fee schedules, and AAPC/AHIMA articles
• Sound time management and ability to manage workload independently
• Strong analytical, problem-solving, research, and creative-thinking skills
• Comfort with CAC/Encoder audits and identifying appropriate code selection
• Equivalent combination of education and experience considered
• Ability to work remotely
• Strong computer proficiency, including Microsoft Word, Excel, and Outlook
• Regular and predictable attendance
• Familiarity with healthcare documentation systems
• Experience with DRGs, APCs, and NCCI fee schedule concepts
• Strong verbal, written, interpersonal communication, and customer service skills
• Ability to communicate audit outcomes and testing results to medically and non-medically oriented staff
• Ability to interpret policies and procedures and communicate complex topics
• Ability to think critically and make decisions within role responsibilities
• Complex Claims medical billing and coding experience strongly preferred

Benefits:

• Professional growth and development opportunities
• Tools, resources, and support for career development
• Flexible, family-oriented work culture
• Work-life balance support
• Remote work option