Denial Medical Coder

1 week ago


Mohali Punjab, India SGH Management India Pvt Ltd Full time

**Denial Medical CoderJob Overview**:
The Denial Medical Coder is responsible for reviewing and analyzing denied medical claims, determining the reasons for denial, and working to resolve those issues. They ensure that claims are accurately coded and compliant with payer policies to facilitate reimbursement. This position also involves collaboration with other healthcare professionals, including billing teams, providers, and insurance companies, to prevent future denials.

**Key Responsibilities**:

- **Review Denied Claims**:

- Analyze denied insurance claims to identify reasons for rejection (e.g., coding errors, missing information, incorrect billing).
- Review payer-specific guidelines to determine if the denial was due to errors in medical coding or other factors.
- **Code Corrections**:

- Reassign or update medical codes (ICD-10, CPT, HCPCS) to ensure accuracy in the resubmission of claims.
- Research appropriate medical coding based on clinical documentation and payer requirements.
- **Appeals Management**:

- Prepare and submit appeals for denied claims with proper documentation, justifications, and coding corrections.
- Communicate with insurance companies to follow up on appeals and resolve outstanding issues.
- **Collaboration with Billing and Coding Teams**:

- Work closely with billing and coding departments to ensure claims are submitted correctly and denials are appropriately addressed.
- Provide feedback to coding staff regarding patterns of claim denials and suggest improvements for accuracy in future submissions.
- **Documentation and Reporting**:

- Maintain records of all denials and appeals, including detailed notes on actions taken and outcomes.
- Generate and review reports on denial trends to identify potential areas for improvement in coding, billing practices, or payer communication.
- **Patient Interaction**:

- In some cases, communicate with patients to explain denial reasons and the steps being taken to resolve the issue.
- **Compliance and Regulations**:

- Ensure all coding and billing practices comply with HIPAA regulations, insurance policies, and federal/state laws.
- Stay updated on coding changes, payer policies, and industry standards to ensure accuracy and compliance.

**Skills and Qualifications**:

- **Education and Certification**:

- High school diploma or equivalent required; associate’s degree in health information management, medical billing and coding, or a related field is preferred.
- Certification as a **Certified Professional Coder (CPC)** or **Certified Coding Specialist (CCS)** is highly preferred.
- **Experience**:

- 1-3 years of experience in medical coding, billing, or claims denial management.
- Knowledge of coding systems (ICD-10, CPT, HCPCS) and familiarity with healthcare insurance policies and reimbursement processes.
- **Technical Skills**:

- Proficiency with medical coding software, electronic health records (EHR), and billing systems.
- Ability to interpret insurance explanations of benefits (EOB) and denial reports.
- **Attention to Detail**:

- Strong analytical skills with the ability to spot errors in coding, documentation, and billing practices.
- Ability to handle large volumes of data with accuracy and efficiency.
- **Communication Skills**:

- Strong written and verbal communication skills to communicate with patients, healthcare providers, and insurance companies.
- Ability to explain complex coding and billing issues to non-medical staff or patients.
- **Problem-Solving**:

- Ability to assess problems, investigate causes of claim denials, and recommend or implement solutions.

Pay: ₹400,000.00 - ₹900,000.00 per year

Schedule:

- UK shift
- US shift

**Experience**:

- total work: 2 years (preferred)
- Medical Coding: 1 year (preferred)

License/Certification:

- CPC, CIC, COC (preferred)

Work Location: In person


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