About the job
Position Summary
We are looking for a meticulous and analytical Certified Professional Coder (CPC) to join our dynamic team at Remote Raven. This pivotal role centers on Denial Management and Revenue Integrity. The ideal candidate is not merely a coder but a resourceful problem-solver capable of investigating the root causes of unpaid claims, rectifying coding errors, and effectively appealing denials.
While the primary focus is on coding, we prioritize candidates with a robust background in hard coding, coding directly from operative reports and medical records without excessive reliance on encoders, and comprehensive experience in end-to-end medical billing.
Key Responsibilities
Denial Management & Coding
• Analyze and resolve complex claim denials arising from coding inaccuracies (CCI edits, medical necessity issues, bundling complications, and modifier applications).
• Review medical records and perform hard coding accurately from documentation to support appeals, ensuring the utmost specificity for ICD-10-CM, CPT, and HCPCS levels.
• Draft and submit thorough appeal letters to payers, referencing appropriate coding guidelines (AMA, CMS) to successfully overturn denials.
• Identify trends in coding denials and provide feedback to the billing team or healthcare providers to mitigate future rejections.
Billing & Revenue Cycle Support
• Leverage medical billing expertise to comprehend the complete lifecycle of a claim, ensuring that corrected codes are entered and rebilled according to payer-specific clearinghouse requirements.
• Verify insurance eligibility and benefits in cases where denials pertain to coverage issues.
• Collaborate with the accounts receivable team to ensure prompt follow-up on aged claims.
Communication & Inbound Support
• Handle inbound inquiries from patients regarding billing questions or from insurance representatives regarding claim statuses.
• Communicate effectively with providers to clarify documentation gaps that contribute to coding denials.
Note: The manager or supervisor may assign tasks outside the key responsibilities and scope of work, limited to the purposes under revenue cycle management.
