PB & HB Coding Edits & Denials Specialist (AAPC or AHIMA Cert. Req.d)

Job description

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Join one of CorroHealth's most established and successful teams, supporting long-term client partnerships through coding excellence. We're seeking a certified ProFee coder who thrives in a remote, autonomous environment and who also has expertise in hospital outpatient/facility denials, coding compliance, and reimbursement optimization. This role combines hands-on denial resolution, payer policy research, coding review, and revenue integrity support, making it ideal for an experienced coder who enjoys solving complex reimbursement challenges while maintaining exceptional quality and productivity standards. This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. This is a remote position. Sadly, we are on high alert for scams, imposters and application fraud. We employ comprehensive screening and verification methods. Any attempt at application fraud or misrepresentation will be identified and lead to immediate removal from consideration. Permanent work status (USC/Greencard) is required Employees must reside within and work within the continental U.S. Candidates will be required to complete a proctored Profee Coding assessment as part of the application process. RESPONSIBILITIES: Team Member must be able to work from home and be independent in their coding skills. Provide various components of coding services to support our clients. Strong experience in ProFee and Hospital Outpatient (Facility) denials. Understanding of Remit & CARC codes Review and resolve denials in EPIC Research payer policies Identify trending denial issues that can be escalated to management Resolve Medical Necessity and CCI edits Code surgical procedures typical of an ER setting to capture additional revenue when appropriate. Apply ICD-10-CM diagnosis codes to the highest level of specificity available. Accurately apply diagnosis codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS Interpret coding guidelines for accurate code assignment Identify the importance of documentation on code assignment and the subsequent reimbursement impact. Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program. Comply with all internal policies and procedures. Actively participate in Company provided training and education. All Coders must maintain at least one credential through either AAPC or AHIMA. Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information MINIMUM QUALIFICATIONS & REQUIREMENTS: All coders MUST be certified through either the AAPC (CPC or COC) or AHIMA (CCS or CCS-P). Must have at least a minimum of 6 months of on-the-job experience. Regular, predictable, and punctual attendance is required. Must have working knowledge and experience with systems such as EMR, Billing, etc Must have a phone, reliable internet connection and current coding materials such as CPT and ICD-10-CM coding references. Will be required to maintain an ongoing productivity level and accuracy rate of 95% or higher Must be proficient in Microsoft programs like Excel and Outlook. Examples include: You should be able to open and add to an Excel spreadsheet abd perform basic formulas like adding or multiplying. You should be able to manage Outlook emails and schedule and attend meetings. Ability to communicate effectively and professionally both verbally and written. Ability to coordinate, analyze, observe, make decisions, and meet deadlines May be required to perform other duties as assigned by Leadership Team Member. We Offer: Quality of life with a remote predictable, full-time schedule Competitive hourly rate commensurate to experience Medical, Dental, Vision coverage and more Long-term disability insurance, and life insurance Ample parental leave 401K with company match Certification and Tuition Reimbursement Holidays, paid time off Keywords: CPC, COC, CCS, CCS-P, ProFee, Profession Fee, Hospital Outpatent, Facility, Denials, Coding, ICD-10, CPT, HCPCS, EPIC PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.