Coding Specialist

ADP, Inc.; Washington (District of Columbia); On-site; USD 65,000 - 90,000; Full time

Job summary

Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support end-to-end appeals and claims recovery operations. You will ensure coding on denied/appealed claims is accurate, compliant, and aligned with payer requirements and client expectations.

You will review complex claims across inpatient/outpatient settings, interpret documentation and payer policies, advise on appeal strategy, and support quality across coding workflows.

Qualifications

• CPC certification or equivalent required; CCS/CRC preferred.
• Minimum 3 years of hands-on medical coding experience with ICD-10, CPT, HCPCS, and modifiers.
• Experience with Medicare/Medicaid and commercial payer rules and policies.

Responsibilities

• Review codes billed based on APR-DRG and MS-DRG for appeals.
• Review denied/underpaid claims and assign ICD-10, CPT, HCPCS codes and modifiers to support appeals.
• Analyze medical records, EOBs, denial letters to identify coding issues and opportunities to overturn denials.
• Interpret payer rules and policies within the appeals and claims recovery process.
• Collaborate with appeals specialists, legal and clinical reviewers to clarify documentation and support case strategy.
• Monitor denial trends and recommend process improvements to reduce denials.
• Develop and maintain standardized coding procedures and templates aligned with regulations.
• Contribute to performance reports on coding accuracy and denial overturn rates.
• Participate in audits and quality reviews; contribute to corrective-action plans.
• Assist onboarding and ongoing training on coding fundamentals and policy updates.

Skills

CPC certification

Strong analytical skills

Excellent communication

Project management

Education

Associate or Bachelor’s degree in related field

High school diploma/GED with relevant experience considered

Job description

Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support our end - to - end appeals and claims recovery operations. This role will be responsible for ensuring that coding applied to denied and appealed claims is accurate, compliant, and strategically aligned with payer requirements and client expectations. Rather than simply coding high - volume encounters, this position will focus on reviewing complex claims, interpreting documentation and payer policies, advising on appeal strategy, and supporting quality and consistency across our coding and denial management workflows.

The Senior Coding Specialist will have visibility across multiple product lines and venues, including inpatient and outpatient hospital claims, professional services, and specialty service lines, as applicable to client engagements. They will help operationalize coding guidelines, regulatory requirements, and client policies; identify coding-related denial trends; recommend corrective actions; and contribute to process improvements that enhance both recovery outcomes and compliance. This role may also provide guidance and education to internal staff and client teams on documentation standards, coding changes, and payer expectations.

Key Responsibilities

• Review codes already billed based on APR - DRG and MS - DRG for appeal.
• Review denied and underpaid claims to confirm and assignappropriate ICD - 10, CPT, HCPCScodesand modifiers, ensuring coding supports appeal arguments andcomplies withpayer and regulatory guidelines.
• Analyze medical records, EOBs, denial and approval letters, and related correspondence toidentifycoding issues, documentation gaps, and opportunities to overturn denials.
• Interpret and apply Medicare, Medicaid, and commercial payer rules and policies, including NCCI edits and medical necessity requirements, within the appeals and claims recovery process.
• Collaborate with appeals specialists, legal and clinical reviewers, and client revenue cycle teams to clarify documentation, resolve coding questions, and support case strategy.
• Monitor coding-related denial trends,assistin root - cause analysis, and recommend process or documentation changes to reduce future denials.
• Support the development and maintenance of standardized coding procedures, guidelines, and templates in alignment with regulatory requirements and client policies.
• Provide input into operational and performance reports related to coding accuracy, denial overturn rates, and documentation quality.
• Participate in audits and quality reviews;identifycoding or documentation errors and contribute to corrective - action plans.
• Assistwith onboarding and ongoing training of team members on coding fundamentals, documentation expectations, and relevant policy or regulatory updates.

Qualifications

• Associate or bachelor's degree in a related field preferred; candidates with a high school diploma/GED and strong relevant experience will be considered.
• Current CPC (Certified Professional Coder) or equivalent coding certification required;additionalcertifications (e.g., CCS, CRC/Risk Adjustment) are preferred.
• Prior experience with health systems, health plans, TPAs, or healthcare legal/consulting organizations, specifically in Coding, Denials/Appeals, or Revenue Cycle Operations.
• Minimum3years of hands  on medical coding experience, withdemonstratedproficiencyinICD  10, CPT, HCPCS, and modifier use.
• Familiarity with Medicare and commercial payer regulations, documentation requirements, and third - party payer issues.
• Strong analytical skills with the ability to synthesize documentation, denial codes, and payer policies into clear coding and appeal recommendations.
• Excellent written and verbal communication skills, with the ability to explain coding decisions and documentation needs to both technical and non - technical stakeholders.
• Strong organizational and time - management skills, with the ability to manage multiple priorities, deadlines, and stakeholders in a fast - paced, metrics - driven environment.