Remote Orthopedic Coding Denials Auditor

EnableComp LLC; United States; Remote; USD 68,000 - 98,000; Full time

Benefits offered by this job

Remote work option

Job summary

EnableComp LLC seeks a Coding Denials Auditor to analyze coded medical services, reports and billed charges to determine the appropriateness of coding and delivery of care, communicating findings across teams.

The role audits outpatient and professional claims, drafts appeals using CPT/AHIMA guidelines, and collaborates with revenue cycle teams. Requires CPC/AHIMA certification and 5+ years orthopedic billing with strong communication and remote-work capabilities.

Qualifications

• Associates or Bachelor’s degree required.
• Current CPC or AHIMA/CCA/CCS/RHIT certification preferred.
• 5+ years orthopedic surgery billing and coding experience.
• Strong written communication for drafting appeals to payors.
• Ability to work remotely with strong time-management.
• Proficiency with MS Office; Excel competency.

Responsibilities

• Conduct coding audits of submitted claims to determine appropriateness of procedure and diagnosis codes billed based on documentation provided for both outpatient facility and professional claims.
• Review billing for accuracy to ensure compliance of proper billing and coding procedures of third-party carriers and to ensure complete and accurate reimbursement.
• Coordinate with revenue cycle teams to investigate rejected or denied claims to determine denial accuracy and work in an inter-departmental collaboration process to assist in claim corrections/appeals.
• Effectively utilizes computer and appropriate software (MS Office Suite) to produce correspondence, charts, spreadsheets and/or other information applicable to the position, including a basic to intermediate level of competency in Excel which is required.
• Maintains knowledge regarding medical coding and/or healthcare market changes.
• Gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.
• Draft appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, state fee schedule language, AAPC/AHIMA articles etc.
• Other duties as required

Skills

Orthopedics billing

Surgery coding

AR management

Denials analysis

Excel proficiency

Education

Associates or Bachelor's degree

Tools

MS Excel

CAC/Encoder audits

Microsoft Office

Job description

EnableComp LLC seeks a Coding Denials Auditor to analyze coded medical services, reports and billed charges to determine the appropriateness of coding and delivery of care, communicating findings across teams.

The role audits outpatient and professional claims, drafts appeals using CPT/AHIMA guidelines, and collaborates with revenue cycle teams. Requires CPC/AHIMA certification and 5+ years orthopedic billing with strong communication and remote-work capabilities.