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Innovaccer is seeking a Coding Specialist to independently review, analyze, and resolve front-end scrubs and denied claims, ensuring accurate and timely claim payment. This role focuses on identifying and correcting coding-related issues prior to claim submission, resubmitting corrected claims, and appealing denied claims using established coding guidelines, payer requirements, and organizational policies.
Key responsibilities include:
- Processing approximately 10 front-end holds/denials per hour
- Reviewing coding and resubmitting corrected claims to insurance carriers
- Creating appeal letters and forms with supporting medical documentation
- Maintaining a minimum 92% coding accuracy rate
- Assigning ICD-10-CM and CPT codes with appropriate modifiers for professional fee services
- Reviewing medical records and documentation to determine appropriate codes for services and diagnoses
- Ensuring all diagnosis codes meet local and national medical necessity guidelines
- Utilizing internal coding resources and payer guidelines for accurate, compliant coding
- Following all HIPAA regulations and maintaining strict privacy and confidentiality standards
- Staying current with laws, regulations, payer policies, and industry guidance
- Independently resolving all assigned front-end claim holds
- Participating in department meetings, one-on-one meetings, and mentorship with the Coding Team Lead
- Escalating client trends and coding questions to the Coding Manager
- Maintaining and completing all continuing education unit (CEU) requirements
The ideal candidate will work in a fast-paced environment with strong attention to detail, foundational coding knowledge, and the ability to work independently while collaborating closely with revenue cycle partners to prevent claim rejections and support clean claim rates.
Requirements:
- Current AAPC or AHIMA Coding Certification (minimum 3 years)
- Minimum 3+ years of professional coding experience
- Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state/federal Medicare reimbursement guidelines
- Prior experience reviewing front-end coding errors before insurance submission
- Prior experience reviewing and correcting coding from insurance denials
- Prior experience submitting corrected claims and appeals
- Prior experience with insurance guidelines and EOBs (Explanation of Benefits)
- Proficiency in proper English grammar, usage, and professional documentation standards
- Ability to research and analyze data, draw logical conclusions, and resolve coding/documentation issues
- Ability to read, interpret, and apply policies, procedures, laws, and regulations
- Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures
- Demonstrated ability to exercise independent judgment in coding and claim resolution
- Excellent written and verbal communication skills, including ability to prepare reports and clarify documentation needs
- Strong commitment to maintaining confidentiality and safeguarding protected health information
- Prior experience working in a medical billing environment with strict HIPAA compliance adherence
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams)
