EnableComp, LLC
  • Operations
  • 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 Senior Coding Denials Auditor 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 Senior Coding Denials Auditor will use their expertise in operative report abstracting, unlisted code analysis, and advanced appeal concepts to communicate to both internal and external clients and payors.


Key Responsibilities

  • Conducts 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.
  • Reviews Billing for accuracy to ensure compliance of proper billing and coding procedures of third-party carriers and to ensure complete and accurate reimbursement of the following denial/edit types including those assigned to Coding Denials Auditor; and in addition the following denial types:
    • Advanced Facility/Profee Diagnosis Code Selection
    • Advanced NCCI Edits/Manual Appeals for Facility and Profee claims
    • Advanced Profee Global Appeals
    • Anesthesia Claims
    • Operative/Clinical report Abstracting for accurate CPT/Modifier coding and appeal for all specialty types including:
      • Orthopedics
      • Gastroenterology
      • Radiology and Interventional Radiology
      • Emergency Department
      • Critical Care/Intensivist Services
      • Physical Therapy
      • Mental Health
      • Urgent Care
    • Pro Fee E/M Leveling & Selection
    • Unlisted Code Appeals
    • Ambulance Claim coding and appeals
  • Coordinates with revenue cycle teams to investigate rejected or denied claims to determin
  • 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 candidate must have 3-5 years of experience in orthopedic and/or surgery coding, a solid background in medical billing, with special emphasis on AR, EOBs, 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 grammatically correct well written appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, 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
  • Must be comfortable with CAC/Encoder audits and be able to identify appropriate code selection from audit findings.
  • Ability and skill set to work remotely
  • Timely and regular attendance
  • 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
  • Equivalent combination of education and experience will be considered

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 grammatically correct well written appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, 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
  • Must be comfortable with CAC/Encoder audits and be able to identify appropriate code selection from audit findings.
  • Ability and skill set to work remotely
  • Timely and regular attendance
  • 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.
  • Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
  • Equivalent combination of education and experience will be considered

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
  • Complex Claims medical billing and coding experience strongly preferred

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