Senior Coding & Appeals Specialist

ADP, Inc.; Washington (District of Columbia); On-site; USD 65,000 - 90,000; Full time

Job summary

Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support end-to-end appeals and claims recovery operations. You will ensure coding on denied/appealed claims is accurate, compliant, and aligned with payer requirements and client expectations.

You will review complex claims across inpatient/outpatient settings, interpret documentation and payer policies, advise on appeal strategy, and support quality across coding workflows.

Qualifications

• CPC certification or equivalent required; CCS/CRC preferred.
• Minimum 3 years of hands-on medical coding experience with ICD-10, CPT, HCPCS, and modifiers.
• Experience with Medicare/Medicaid and commercial payer rules and policies.

Responsibilities

• Review codes billed based on APR-DRG and MS-DRG for appeals.
• Review denied/underpaid claims and assign ICD-10, CPT, HCPCS codes and modifiers to support appeals.
• Analyze medical records, EOBs, denial letters to identify coding issues and opportunities to overturn denials.
• Interpret payer rules and policies within the appeals and claims recovery process.
• Collaborate with appeals specialists, legal and clinical reviewers to clarify documentation and support case strategy.
• Monitor denial trends and recommend process improvements to reduce denials.
• Develop and maintain standardized coding procedures and templates aligned with regulations.
• Contribute to performance reports on coding accuracy and denial overturn rates.
• Participate in audits and quality reviews; contribute to corrective-action plans.
• Assist onboarding and ongoing training on coding fundamentals and policy updates.

Skills

CPC certification

Strong analytical skills

Excellent communication

Project management

Education

Associate or Bachelor’s degree in related field

High school diploma/GED with relevant experience considered

Job description

Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support end-to-end appeals and claims recovery operations. You will ensure coding on denied/appealed claims is accurate, compliant, and aligned with payer requirements and client expectations.

You will review complex claims across inpatient/outpatient settings, interpret documentation and payer policies, advise on appeal strategy, and support quality across coding workflows.