Remote Claims Coding Specialist – Healthcare Disputes

Capitol Bridge, Llc; Puerto Rico; Híbrido; USD 26.000 - 36.000; Jornada completa

Descripción de la vacante

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 serves as the coding subject matter expert, evaluating billed services and documentation against coding guidance.

The ideal candidate holds CPC/CCS/CCS-P or comparable credentials, with 3+ years of professional medical coding, claims auditing, or healthcare billing

Formación

• Current professional coding certification such as CPC/CCS/CCS-P or equivalent.
• Minimum three years of professional medical coding, claims auditing, or healthcare billing experience.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, modifiers, EOBs, and claim documentation.
• Ability to interpret coding guidance and document clear conclusions.

Responsabilidades

• 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 clinical questions to the appropriate credentialed reviewer.
• 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.

Conocimientos

CPC

CCS

CCS-P

Healthcare coding knowledge

Descripción del empleo

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 serves as the coding subject matter expert, evaluating billed services and documentation against coding guidance.

The ideal candidate holds CPC/CCS/CCS-P or comparable credentials, with 3+ years of professional medical coding, claims auditing, or healthcare billing