Coding Escalation Specialist- Pro Fee Hospital

Ventra Health; United States; On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Discretionary incentive bonuses

Inclusive workplace environment

Job summary

Ventra Health is seeking a Medical Coding Escalation Specialist to manage complex coding issues and provide expert-level support. You will conduct thorough reviews of medical records for accurate coding and ensure compliance with regulations.

The ideal candidate will have 3-5 years of medical coding experience, AAPC or AHIMA certification, and strong analytical skills. Join us in fostering a diverse and inclusive workplace.

Qualifications

• Minimum 3-5 years of experience in medical coding, focusing on complex case review.
• AAPC or AHIMA certification is required.
• Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems.

Responsibilities

• Handle escalated coding issues from the team.
• Analyze medical records for accurate code assignment.
• Educate and mentor staff on coding updates.

Skills

ICD-10-CM coding

CPT coding

HCPCS coding

Analytical skills

Communication skills

Education

AAPC or AHIMA certification

3-5 years of experience in medical coding

Tools

EHR systems

Coding software systems

Microsoft Excel

Job description

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Job Summary

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.

Essential Functions And Tasks

• 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.

Education And Experience Requirements

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

Knowledge, Skills, And Abilities

• 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 and 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.

Compensation

• Base compensation will be based on factors such as geographic location, skill set, experience, and qualifications.
• This position is also eligible for discretionary incentive bonuses in accordance with company policies.

Equal Employment Opportunity (Applicable only in the US)

Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.