Coding Denials Auditor

The company provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, the company provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, the company removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. The company is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

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

Key Responsibilities

• 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 of 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.

• Gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.

• Draft 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.

Requirements and 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.

• The applicant must have a strong background in orthopedics and surgery billing/coding. The ideal candidate has 5+ years of experience in orthopedic surgery billing, a solid background in coding and medical billing, with special emphasis on AR, EOB's, and overall account management, including coding denials.

• Must be able to gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.

• Must have strong written communication skills. This position requires the ability to draft grammatically correct well written appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, state fee schedule language, AAPC/AHIMA articles etc.

• 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

• Must be comfortable with CAC/Encoder audits and be able to identify appropriate code selection from audit findings.

• Equivalent combination of education and experience will be considered.

• Ability and skill set to work remotely.

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions

• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).

• Regular and predictable attendance.

Special Considerations and Prerequisites

• 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.

The company 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. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.

The company recruits, develops and retains the industry's top talent.  As the employer of choice in the complex claims industry, the company takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people.  We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At the company, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies.  If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then the company is the place for you.

Don’t just take our word for it!  Hear what our people are saying

“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist

“I enjoy working for the company because of the Core Values we believe in. The company stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations