Edits & Denials Medical Coder

CorroHealth; Dadri; On-site; INR 450,000 - 650,000; Full time

Job summary

CorroHealth is seeking an Edits & Denials Medical Coder to review, analyze, and correct coding-related claim edits and denials to ensure accurate reimbursement and regulatory compliance.

You will work across Coding, Billing, Revenue Cycle, and Payer Operations, handling denial management, claim edits, and coding corrections while ensuring adherence to CMS, HIPAA, and payer guidelines. The role emphasizes accuracy, auditing, and collaboration with clinical departments.

Qualifications

• Strong knowledge of ICD-10-CM, CPT, HCPCS and modifiers.
• Understanding of payer guidelines and denial management processes.
• Knowledge of Medicare, Medicaid and commercial insurance policies.
• Strong analytical and problem-solving skills.
• Experience with EHR/EMR systems, encoder tools, and claim processing platforms.
• Ability to interpret EOBs, remittance advice, and denial codes.

Responsibilities

• Review denied medical claims to identify root cause.
• Resolve coding-related denials from Medicare, Medicaid, and payers.
• Correct diagnosis, procedure, modifier, and billing errors leading to denials.
• Prepare and submit claim corrections and rebills as required.
• Track denial trends and recommend preventive actions.
• Review front-end and back-end claim edits before claim submission.
• Resolve coding, demographic, authorization, and medical necessity edits.
• Ensure claims pass payer-specific and clearinghouse edits.
• Work on NCCI and payer edit resolutions.
• Review medical records to validate diagnosis and procedure coding.
• Identify undercoding, overcoding, and missed charges.
• Correct coding discrepancies to support accurate reimbursement.
• Prepare and submit appeal documentation for denied claims.
• Draft coding rationales and supporting documentation for appeal requests.
• Collaborate with providers and clinical departments to obtain additional documentation.
• Monitor appeal outcomes and maintain appeal records.
• Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and payer-specific guidelines.

Skills

ICD-10-CM

CPT/HCPCS

Denial management

Payer guidelines

EHR/EMR systems

Remittance codes

Job description

Roles & Responsibilities

An Edits & Denials Medical Coder is responsible for reviewing, analyzing, correcting, and resolving coding-related claim edits and denials to ensure accurate reimbursement and compliance with payer regulations. This role serves as a critical link between Coding, Billing, Revenue Cycle, and Payer Operations.

1. Denial Management

• Review and analyze denied medical claims to identify the root cause.


• Resolve coding-related denials from Medicare, Medicaid, and commercial payers.


• Correct diagnosis, procedure, modifier, and billing errors leading to denials.


• Prepare and submit claim corrections and rebills as required.


• Track denial trends and recommend preventive actions.

2. Claim Edit Resolution

• Review front-end and back-end claim edits before claim submission.


• Resolve coding, demographic, authorization, and medical necessity edits.


• Ensure claims pass payer-specific and clearinghouse edits.


• Work on National Correct Coding Initiative (NCCI) and payer edit resolutions.

3. Coding Review & Correction

• Review medical records to validate diagnosis and procedure coding.


• Ensure proper assignment of ICD-10-CM, CPT, HCPCS, and modifiers.


• Identify undercoding, overcoding, and missed charges.


• Correct coding discrepancies to support accurate reimbursement.

4. Appeals & Reconsiderations

• Prepare and submit appeal documentation for denied claims.


• Draft coding rationales and supporting documentation for appeal requests.


• Collaborate with providers and clinical departments to obtain additional documentation.


• Monitor appeal outcomes and maintain appeal records.

5. Compliance & Regulatory Adherence

• Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and payer-specific guidelines.


• Follow AHIMA, AAPC, ICD-10-CM, CPT, and HCPCS coding standards.


• Maintain audit-ready documentation and coding practices.


• Participate in compliance audits and quality reviews.

6. Denial Trend Analysis

• Analyze recurring denial patterns and identify root causes.


• Generate denial reports and performance dashboards.


• Recommend process improvements to reduce future denials.


• Support revenue cycle initiatives to improve clean claim rates.

7. Collaboration & Stakeholder Management

• Work closely with Coding, Billing, CDI, Revenue Cycle, and Provider teams.


• Communicate denial findings and corrective actions to relevant stakeholders.


• Assist in educating staff on documentation and coding requirements.


• Support process improvement and workflow optimization projects.

8. Quality Assurance

• Perform quality checks on corrected claims and appeal submissions.


• Maintain productivity and accuracy standards.


• Ensure timely resolution of edits and denials according to established TATs.


• Monitor key denial and recovery metrics.

9. Continuous Learning

• Stay current on ICD-10-CM, CPT, HCPCS, and payer policy updates.


• Attend coding, compliance, and denial management training sessions.


• Maintain coding certifications and continuing education requirements.

Required Skills

• Strong knowledge of ICD-10-CM, CPT, HCPCS, and modifier assignment.


• Understanding of payer guidelines and denial management processes.


• Knowledge of Medicare, Medicaid, and commercial insurance policies.


• Strong analytical and problem-solving skills.


• Experience with EHR/EMR systems, encoder tools, and claim processing platforms.


• Ability to interpret EOBs, remittance advice, and denial codes.

Preferred Qualifications

• CPC, CCS, CRC, CIC, COC, or equivalent coding certification.


• Experience in Medical Coding, Revenue Cycle Management, or Denials Management.


• Knowledge of payer appeals and reimbursement methodologies.