Medical Coder

DaMar Staffing; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

DaMar Staffing is seeking a Remote Medical Coder with CPC/CCS certification to review medical records for Medicare appeals. You will evaluate NCD/LCD denials, duplicate denials, and MUE denials, determining if conditions of coverage exist and providing uphold justifications where needed.

Primary FACETS experience with COSMOS expansion is expected. Maintain thorough documentation, communicate with the team, and stay current with CMS policies.

Qualifications

• Must hold CPC or CCS coding certificate.
• Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE).
• Experience with FACETS (primary) and COSMOS (secondary).
• Excellent analytical and problem-solving skills.
• Attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to work independently and as part of a team.
• Familiarity with CMS guidelines and Medicare policies.

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.
• Initially focus on FACETS cases, with plans to expand to COSMOS cases.
• Handle additional coding-related scenarios as the team expands.

Skills

Medicare appeals experience

Analytical thinking

Attention to detail

Written and verbal communication

Independent / team work

Education

Coding certificate (CPC/CCS)

Tools

FACETS

COSMOS

Job description

Role

Medical Coder

Location

Remote

Function Asks

• We are seeking dedicated and detail-oriented specialists who possess a 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.

Volumes

• 300 cases per week

FTEs

• 1 domestic resources

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.
• Initially focus on FACETS cases, with plans to expand to COSMOS cases.
• Handle additional coding-related scenarios as the team expands.

Qualifications

• Coding certificate (CPC, CCS, or equivalent).
• Strong understanding of medical records review.
• Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE).
• Experience with FACETS (primary).
• Experience with COSMOS (secondary).
• Excellent analytical and problem-solving skills.
• Attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to work independently and as part of a team.
• Familiarity with CMS guidelines and Medicare policies.

Preferred Qualifications

• Previous experience in a similar role.
• Knowledge of healthcare regulations and compliance.