[Hiring] Coding Escalation Specialist @Ventra Health, Inc.

Role Description

The Medical Coding Escalation Specialist is responsible for handling complex coding issues, resolving coding-related escalations, and providing expert-level support to the medical coding team. This role involves conducting thorough reviews of medical records, ensuring accurate code assignment, and serving as a liaison between coders, auditors, providers, and compliance teams. The specialist ensures coding practices adhere to regulatory requirements, payer policies, and internal standards.

• Review and resolve escalated coding issues from coders, auditors, billing teams, and providers.
• Analyze medical records and documentation to ensure accurate and compliant code assignment.
• Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules.
• Identify coding trends, discrepancies, and compliance risks; recommend corrective actions.
• Participate in coding audits and assist in implementing audit recommendations.
• Educate and mentor coding staff on complex cases and updates to coding regulations.
• Ensure adherence to all applicable coding standards (CMS, AHA Coding Clinic, AMA CPT Assistant).
• Support continuous improvement initiatives in coding accuracy, workflow, and documentation quality.
• Maintain up-to-date knowledge of coding updates, regulatory changes, and payer guidelines.

Qualifications

• Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance.
• AAPC or AHIMA certification required.

Requirements

• Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
• Strong understanding of CMS regulations and payer-specific guidelines.
• Excellent analytical, problem-solving, and decision-making skills.
• Effective communication and interpersonal skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Experience with electronic health records (EHRs) and coding software systems.
• Ability to read, understand, and apply state/federal laws, regulations, and policies.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
• Ability to remain flexible and work within a collaborative and fast-paced environment.
• Basic use of computer, telephone, internet, copier, fax, and scanner.
• Basic touch 10 key skills.
• Basic Math skills.
• Understand and comply with company policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Benefits

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.