[Hiring] Coder, Edits/ Denials @Ovation Healthcare

Role Description

Ovation Healthcare seeks 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.

• 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.

Qualifications

• 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.
• Must meet and maintain a 95% quality accuracy rate and productivity standards.
• Must be able to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics.
• Must have experience working in a remote environment.

Requirements

• CCS, AHIMA, CCS-P, CPC, AAPC, CPC-A, or AAPC Credentials.
• Three or more years of Coding experience.

Work Conditions and Physical Requirements

• Reliable high-speed internet connection is required for all remote/hybrid positions.
• Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.
• A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions.
• No use of public Wi-Fi unless connected through a secure company-provided VPN.
• Compliance with all applicable HIPAA privacy and security regulations.