[Hiring] Coding Denials Auditor @EnableComp

Role Description

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

• 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 with 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.
• Gathers and analyzes claims and medical records information pertinent to documentation findings and outcomes; uses this information to make educated decisions.
• Drafts 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.

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.
• Strong background in orthopedics and surgery billing/coding.
• 5+ years of experience in orthopedic surgery billing, with a solid background in coding and medical billing, emphasizing AR, EOBs, and overall account management, including coding denials.
• Strong written communication skills, with the ability to draft grammatically correct well-written appeals to payors.
• 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.
• Comfortable with CAC/Encoder audits and able to identify appropriate code selection from audit findings.
• Ability and skill set to work remotely.
• Strong computer proficiency and understanding of basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.

Requirements

• 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.

Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V.
• All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status.
• Commitment to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
• Continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people.