Senior Medical Coder

Essential Job Responsibilities & Key Performance Outcomes

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, 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 our 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 Lyric business rules
• Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines

Required Qualifications

• BS Nursing, BS Pharmacy or equivalent required
• 5 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is required. Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also 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) is required

Preferred Qualifications

• Previous experience using AI tools in a professional environment
• Previous experience at CMS (Medicare or Medicaid) or at a Health Insurance plan
• Ability to convey complex technical information across various formats (written, verbal, visual)
• Comfortable working in agile, fast-paced, and collaborative environments
• Willing to participate in target AI training programs
• Self-motivated and proactive, with the ability to work independently and with minimal supervision
• Strong analytical and critical thinking skills

Benefits:

• Company Christmas gift
• Health insurance
• Life insurance
• Opportunities for promotion
• Promotion to permanent employee
• Work from home

Application Question(s):

• Are you a Nursing Graduate?
• How much is your expected salary?

Work Location: Remote