Medical Coder

Wipro Technologies; Atlanta (GA); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking dedicated Medical Coders to join their remote team. In this full-time role, you will leverage your medical coding expertise to manage Medicare appeals and ensure compliance with CMS guidelines. You will analyze medical records, provide uphold justifications, and maintain meticulous documentation. This position offers a unique opportunity to contribute to an innovative team while enjoying the flexibility of working from home. If you are detail-oriented and passionate about healthcare coding, this is the perfect chance to advance your career in a supportive environment.

Qualifications

• Strong understanding of medical records review and Medicare appeals.
• Experience with denied claims review as an auditor/examiner.

Responsibilities

• Review and analyze medical records for Medicare appeals.
• Maintain accurate documentation of all reviews and decisions.

Skills

Medical Coding Certificate

Medicare Appeals

Records Review

Documentation

Communication

Education

High School or equivalent

Coding certificate (CPC, CCS, or equivalent)

Tools

FACETS (Trizetto)

Cosmos

Job description

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Title: Medical Coder

Requisition ID: 60201

City: Atlanta

Country/Region: US

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.

We are continuing to grow! Come grow with us!!!

Job-Type: This is a remote/work from home (WFH), full-time direct hire position.

Job Description: Our team is seeking dedicated and detail-oriented medical coding specialists who possess a Medical Coding Certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if conditions of coverage exist. If conditions are not met, the specialist will provide an uphold justification.

Key Responsibilities:

Review and analyze medical records for Medicare appeals.

Work on NCD/LCD denials, Duplicate denials, and MUE denials.

Compare medical findings to CMS guidelines.

Determine if conditions of coverage are met.

Provide uphold justifications when conditions of coverage are not met.

Maintain accurate and detailed documentation of all reviews and decisions.

Communicate effectively with team members and other stakeholders.

Stay updated with CMS guidelines and changes in Medicare policies.

Handle additional coding-related scenarios as the team expands.

Basic Requirements:

• High School or equivalent
• Coding certificate (CPC, CCS, or equivalent).
• Previous WFH experience with high-speed internet with HIPPA compliant office.
• Strong understanding of medical records review.
• Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE).
• Experience with FACETS (Trizetto)
• Must have experience with denied claims review as an auditor/examiner.

More detailed skills:

• HCFA Billing (CMS 500)
• Frequent Denials:
  • CO11 Dx – diagnosis code mismatch with procedure
  • CO5 POS – Procedure code mismatch
  • CO97 – Bundling issues
  • CO50 – Medical necessity
  • CO4 – Missing Modifier
• Difference between LCD and NCD with examples - (Local Claim Denial) and (National Claims Denial)
• Software tools - Facets (TriZetto) , Cosmos a plus
• G2211 Denial
• Forms:
  • CMS- 1500
  • UB – 04 (CMS 1450)
  • EDI 837
  • EDI 835
• CARC – Claim Adjustment Reason Codes
• RARC – Remittance Advice Remark Codes
• Have you ever worked for Wipro or UHG?

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Any complaints or concerns regarding unethical/unfair hiring practices should be directed to our Ombuds Group [e-mail] .

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.

Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.