Medical Coding Specialist: Denials & Clean Claims Expert

Innovaccer Analytics; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

20 days fixed time off per year

Generous parental leave

Recognition & rewards

Comprehensive insurance coverage (med,

Disability & life insurance

Optional legal aid & pet insurance

Job summary

Innovaccer Inc. is seeking a Coding Specialist to independently review front-end scrubs and denied claims, correct coding errors, and submit revised claims. This role applies CPT/ICD-10-CM guidelines, payer requirements, and HIPAA policies to promote accurate reimbursement.

You will assign codes, review medical records for documentation adequacy, and prepare appeal letters. The ideal candidate holds AAPC or AHIMA certification, 3+ years of coding experience, and strong Excel skills.

Qualifications

• Must hold a current AAPC or AHIMA Coding Certification for a minimum of 3 years.
• Minimum of 3+ years of professional coding experience.
• Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines.
• Prior experience in reviewing front end coding errors before submitting to insurance
• Prior experience in reviewing and correcting coding from insurance denials.
• Prior experience in submitting corrected claims and appeals.
• Prior experience with insurance guidelines and EOBs.
• Familiarity with proper English grammar, usage, and professional documentation standards.
• Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues.
• Ability to read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures.
• Demonstrated ability to exercise independent judgment in coding and claim resolution.
• Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff.
• Strong commitment to maintaining confidentiality and safeguarding protected health information.
• Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements.
• Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams).

Responsibilities

• Independently reviews and resolves all assigned front-end claim holds.
• Reviews coding and resubmits corrected claims to insurance.
• Creates appeal letters/forms with medical documentation.
• Maintains a minimum of 92% coding accuracy.
• Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment.
• Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses.
• Ensures all diagnosis codes meet local and national medical necessity guidelines.
• Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services.
• Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.
• Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices.
• Independently reviews and resolves all assigned front-end claim holds.
• Escalates identified client trends to the assigned Coding Manager.
• Escalates all coding-related questions to the assigned Coding manager for guidance and clarification.
• Maintains and completes all CEU requirements.
• Performs other duties or tasks as assigned

Skills

CPT & ICD-10-CM coding

Medical terminology

Anatomy & physiology

HIPAA compliance

Documentation interpretation

Independent judgment

Microsoft Office (Word, Excel, Outlook

Education

AAPC or AHIMA Coding Certification

Job description

Innovaccer Inc. is seeking a Coding Specialist to independently review front-end scrubs and denied claims, correct coding errors, and submit revised claims. This role applies CPT/ICD-10-CM guidelines, payer requirements, and HIPAA policies to promote accurate reimbursement.

You will assign codes, review medical records for documentation adequacy, and prepare appeal letters. The ideal candidate holds AAPC or AHIMA certification, 3+ years of coding experience, and strong Excel skills.