Identifies, reviews, and interprets third-party payments, adjustments, and coding denials for professional services. Reviews provider documentation to determine appropriate coding and initiates corrected claims and appeals. Performs hands-on coding, documentation review, and other coding-related tasks for ICD-9, ICD-10, CPT, HCPCS, and modifier usage/linkage.
Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects. Reviews rejected claims, patient inquiries, claim forms, EOBs, and other correspondence to identify coding corrections, rebilling needs, and account resolution actions.
Monitors A/R days, denial and non-payment trends, and supports follow-up activity to help maintain expected performance levels. Communicates with insurance representatives, office staff, and internal teams to resolve claims issues, reduce future denials, and support patient financial services operations.
Maintains knowledge of coding and billing guidelines, federal and state regulations, managed care contracts, and audit requirements. Participates in process improvement efforts, meetings, committee work, and departmental education as needed.
High school diploma or equivalent, plus specialized training associated with attainment of a recognized coding certificate.
Current certification required: CP, CPC-A, or CCS-P.
1-2 years of experience in billing, coding, denial management, or a related field.
Ability to work independently, use good judgment, solve problems, stay organized, and collaborate effectively with staff, peers, and management.
Strong communication skills, adaptability to frequent interruptions, and ability to accept feedback and take corrective action.
Must maintain coding certification requirements and stay current on CMS, AMA, LCDs/LMRPs, CCI edits, Medicare bulletins, and fee schedule updates.
Location
Massachusetts, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 months ago