Claim Edit/Denial Coder

Signature Performance, Inc.•,

8d•Onsite

About The Position

In the role of Claim Edit/Denial Coder, you will be responsible for reviewing and resolving claim coding-related claim edits, rejections, and denials within Epic. This involves reviewing, researching, and resolving professional fee and facility coding edits, claim rejections, and payer denials within Epic work queues for multiple specialties. You will navigate Epic patient encounters, chart review, coding review tools, charge review, account notes, claim edit details, denial information, and related work queues to determine the appropriate coding action. You will also review provider documentation in Epic to validate CPT, HCPCS, ICD-10-CM, modifiers, units, place of service, and other coding elements prior to claim correction or resubmission. Additionally, you will correct coding-related issues in Epic or communicate required corrections to billing, revenue integrity, coding leadership, or other appropriate teams. You will document denial findings, coding rationale, and follow-up actions in Epic notes, work queue comments, or designated tracking tools. The role also includes investigating and resolving coding-related denials from payers to support accurate reimbursement, reduce rework, and promote denial prevention. Finally, you will identify trends in Epic work queue edits, payer denials, documentation gaps, modifier usage, diagnosis sequencing, or charge capture issues and escalate opportunities for education or process improvement.

Requirements

Minimum of 2 years of Medical Coding experience required.
CCS, CCS-P, CPC, RHIT, or RHIA certification required.
Experience using Epic for claim edit resolution, coding work queues, charge review, account review, encounter review, chart review, and/or denial follow-up strongly preferred.
Experience with CPT, ICD-10, HCPCS and Modifiers.
Experience with Professional Fee Coding.
Experience with Facility coding.
U.S. Citizenship or naturalized citizenship is required.
All work must be completed in the continental United States, Alaska, or Hawaii.

Nice To Haves

Are you a team player and a self-motivator?
What is your experience with conducting business in a way that is credit to a company?
Manage multiple projects using your problem-solving skills.
What is uncommon about you?
Are you highly committed?
Are you team-oriented?
Do you value professionalism, trust, honesty, and integrity?

Responsibilities

Review, research, and resolve professional fee and facility coding edits, claim rejections, and payer denials within Epic work queues for multiple specialties, including but not limited to: NCD/LCD medical necessity edits, MUE edits, Primary diagnosis code edits, NCCI edits, Device code edits, Modifier edits, Place of service edits, Charge, diagnosis, procedure, and claim-level coding edits routed through Epic work queues.
Navigate Epic patient encounters, chart review, coding review tools, charge review, account notes, claim edit details, denial information, and related work queues to determine the appropriate coding action.
Review provider documentation in Epic to validate CPT, HCPCS, ICD-10-CM, modifiers, units, place of service, and other coding elements prior to claim correction or resubmission.
Correct coding-related issues in Epic or communicate required corrections to billing, revenue integrity, coding leadership, or other appropriate teams based on workflow and security access.
Document denial findings, coding rationale, and follow-up actions in Epic notes, work queue comments, or designated tracking tools in accordance with departmental standards.
Investigate and resolve coding-related denials from payers to support accurate reimbursement, reduce rework, and promote denial prevention.
Identify trends in Epic work queue edits, payer denials, documentation gaps, modifier usage, diagnosis sequencing, or charge capture issues and escalate opportunities for education or process improvement.