Healthcare Claims Coding Specialist – Disputes

Capitol Bridge PR, LLC; United States; On-site; USD 26,000 - 36,000; Full time

Job summary

Capitol Bridge Puerto Rico is seeking an experienced Claims Coding Specialist to provide specialized coding and billing analysis for healthcare claim disputes supporting the Florida CDR and multi-state IRO programs. This role will serve as the team's coding SME, evaluating billed services, modifiers, diagnoses, and related claim information against records and coding guidance.

Payrate is $22.50/hr. The candidate will review disputed claims, research coding guidance, document rationale, and

Qualifications

• Three years of professional medical coding or claims auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10-CM and modifiers.
• Excellent written and verbal English communication.
• Ability to research coding guidance and document conclusions.

Responsibilities

• Review disputed healthcare claims for coding, billing, and documentation issues requiring specialized analysis.
• Evaluate CPT, HCPCS, ICD-10-CM, modifiers, units, and other applicable claim elements against the submitted documentation and relevant guidance.
• Analyze EOBs, claim forms, medical records, billing records, and supporting materials to identify coding discrepancies or documentation gaps.
• Provide objective coding findings to RN reviewers, physicians, attorneys, and program leadership for incorporation into dispute reviews.
• Distinguish coding and billing questions from clinical medical-necessity issues and escalate when needed.
• Research and apply current governmental and professional coding guidance relevant to the services under review.
• Document coding rationale clearly enough to support review findings, quality review, and auditability.
• Assist with development and maintenance of coding job aids, reference materials, and reviewer guidance as requirements change.
• Participate in Quality Assurance/Quality Control reviews, calibration discussions, training, and complex-case consultation.
• Complete assignments within required turnaround times and comply with privacy, security, project, and company requirements.

Skills

CPT knowledge

HCPCS knowledge

ICD-10-CM knowledge

Documentation & reasoning

English communication

Education

CPC/CCS/CCS-P certification

Job description

Capitol Bridge Puerto Rico is seeking an experienced Claims Coding Specialist to provide specialized coding and billing analysis for healthcare claim disputes supporting the Florida CDR and multi-state IRO programs. This role will serve as the team's coding SME, evaluating billed services, modifiers, diagnoses, and related claim information against records and coding guidance.

Payrate is $22.50/hr. The candidate will review disputed claims, research coding guidance, document rationale, and