EnableComp, LLC
  • Managed Care
  • Franklin, TN, USA
  • Full Time

Comprehensive Benefits package including 401k!

Our Mission

We partner with healthcare providers to maximize reimbursement from complex claims payers by having the best people, processes, products and performance.

Our Vision

We enable healthcare providers to do what they do best.

Position Summary

The Medical Coding Specialist provides analysis of coded medical services, reports, records and billed charges, etc. to determine appropriateness of the medical coding utilized, delivery of care and treatment plans. The Medical Coding Specialist will use his/her expertise and coding expertise to communicate internally and externally.

Key Responsibilities

  • Conducts coding audits of submitted claims to determine appropriateness of procedure and diagnosis codes billed based on documentation provided for both facility and professional claims.
  • Coordinates with revenue cycle teams to investigate rejected or denied claims to see why denial was issued and work in collaboration with other areas to correct
  • Documents persuasive coding-review audits to maximize provider reimbursement.
  • Assists the Medical Coding Manager with identifying coding trends within the organization
  • Effectively utilizes computer and appropriate software (Microsoft Office Suite) to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment
  • Assists other departments regarding evaluation of medical records, procedure or diagnosis code questions, ambiguous, or non-specific medical documentation identified regarding coding protocol related to provider disputes or appeal.
  • Maintains knowledge regarding medical coding and/or healthcare market changes.
  • Other duties as required.

Requirements and Qualifications

  • Associates or Bachelor's Degree
  • Current certification in one of the following:
    • Certified Professional Coder (CPC) or related certification by AAPC
    • Certified Coding Associate (CCA) by AHIMA
    • Certified Coding Specialist (CCS) by AHIMA
    • Registered Health Information Technician (RHIT) by AHIMA
  • The applicant must have a strong background in orthopedics and surgery billing/coding. The ideal candidate has 5+ years of experience in orthopedic surgery billing, a solid background in coding and medical billing, with special emphasis on AR, EOB's and overall account management, including coding denials.
  • Must be able to gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.
  • Must have strong written communication skills. This position requires the ability to draft well written appeals to payors using nationally sourced coding guidelines such as CPT Assistant, state fee schedule language, AAPC/AHIMA articles etc.
  • Sound time management skills with the ability to manage workload independently
  • Strong analytical, problem solving and research skills with the ability to utilize creative thinking
  • Experience in medical coding for Workers' Compensation hospital billing strongly preferred
  • General computer skills including a basic to intermediate level of competency in Excel is required.
  • Must be comfortable with CAC/Encoder audits and be able to identify appropriate code selection from audit findings.
  • Equivalent combination of education and experience will be considered
  • Ability to work remotely but must be in the Tennessee area
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

  • Familiarity with healthcare documentation systems
  • Experience with multiple fee schedule concepts such as DRGs, APCs, and NCCI.
  • Strong verbal, written and interpersonal communication and customer service skills
  • Ability to communicate audit outcomes and testing results with other staff within the company who are both medically and non-medically oriented
  • Ability to interpret policies and procedures and communicate complex topics to others
  • Ability to think critically and make decisions within individual role and responsibility
  • Veterans' Administration and MVA medical billing and coding experience a plus

EnableComp, LLC
  • Apply Now

  • * Fields Are Required

    What is your full name?

    How can we contact you?

  • Sign Up For Job Alerts!

  • Follow Jobs:
  • Follow Our Jobs On Facebook
  • Share This Page