Medical Coder

About the role

This role involves providing clinical content support for medical coding, billing, and claims processing. You will work with diagnosis codes, procedure codes, and clinical criteria to support denial management and claims review processes.

Key responsibilities

• Provide additions, deletions or updates to diagnosis codes, procedure codes, quantity limitations, place of service limitations and other clinical content criteria
• Provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria
• Provide clinical content support to customers as needed
• Perform data entry of clinical content updates into database, as needed
• Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules
• Make recommendations within the software for the criteria on medical claims based on coding guidelines

About you

• BS Nursing or equivalent required
• 4 years' experience in medical billing, coding, claims processing, bill and/or chart review/auditing required
• Previous experience working with US health insurance payers in a claims, appeals or coding capacity required
• Experience in denial management or claim review management is a plus
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
• Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Visio; JIRA; SharePoint with MS project a plus
• AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) required