Medical Coding Specialist: Denials & Compliance

Mercyhealth Wisconsin and Illinois; United States; Remote; USD 33,000 - 49,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA Options

Paid time off

Tuition and certification reimbursemen

Job summary

Mercyhealth Wisconsin and Illinois is seeking a skilled Medical Coding Auditor to review documentation, identify discrepancies, and educate partners on coding practices. The role emphasizes accuracy across outpatient and inpatient coding and requires strong Epic billing knowledge.

Qualified candidates will hold CPC/CPC-H certification and have at least three years of experience in hospital or professional coding, with familiarity in denial management. Competitive pay and benefits are offered.

Qualifications

• Certified in professional or hospital coding (CPC, CPC-H) or other equivalent coding certification required.
• Three years of experience coding professional or hospital services in an outpatient or clinic setting preferred.
• Knowledge of denial management preferred.

Responsibilities

• Reviews, analyzes, and interprets documentation and identifies discrepancies between the code selection and the documentation; corrects them, and presents findings and education to the appropriate partner.
• Resolves pre-bill claim edits from all areas and as identified by claims scrubbing software.
• Maintains a close working relationship with departmental staff, frequently querying them and providing education when coding discrepancies arise.
• Researches and provides education to all partners regarding CMS policies related to outpatient coding, inpatient coding, and professional fee coding, and presents findings to them.
• Solves complex billing and claim denial issues related to coding by researching policies and guidelines.
• Demonstrates extensive knowledge of official coding guidelines established by the AMA, CMS and contracted payers.
• Has a thorough understanding of the differences between professional coding in a clinic setting as compared to a hospital setting (outpatient and inpatient).
• Maintains an in-depth knowledge of Epic billing, ambulatory, and hospital modules.
• Responds to customer concerns through coding reviews requested by other departments.
• Assists with all coding functions at or above the level of a Medical Coding 1 job description.
• Works as a team to achieve productivity goals.

Skills

Medical coding

Denial management

Epic billing

Communication skills

Education

CPC or CPC-H certification

High School Diploma

Tools

Epic billing

Job description

Mercyhealth Wisconsin and Illinois is seeking a skilled Medical Coding Auditor to review documentation, identify discrepancies, and educate partners on coding practices. The role emphasizes accuracy across outpatient and inpatient coding and requires strong Epic billing knowledge.

Qualified candidates will hold CPC/CPC-H certification and have at least three years of experience in hospital or professional coding, with familiarity in denial management. Competitive pay and benefits are offered.