Denial Management Specialist – Orthopedic Services

🕒 Julho 17

🐊 Florida – Remoto

🐊 Florida – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

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HCCS - Healthcare Coding & Consulting Services

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2006

💼 Consultoria

🏥 Saúde

📋 Conformidade

Consulting • Healthcare • Compliance

HCCS - Healthcare Coding & Consulting Services é uma prestadora de serviços dos EUA especializada em codificação médica remota, auditoria de documentação, melhoria de documentação clínica (CDI), validação clínica de DRG, serviços de HIM e suporte a interface/EHR para prestadores de serviços de saúde. Eles empregam apenas codificadores e auditores baseados nos EUA, com ênfase na precisão da codificação, auditorias focadas em regulamentação/conformidade e integração com sistemas EHR comuns (EPIC, Meditech, CPSI). A HCCS atende hospitais e parceiros de saúde com serviços B2B e também contrata e treina profissionais de codificação.

Descrição

• Support orthopedic revenue cycle and denial management operations • Understand the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals • Initially focus on orthopedic denials and ERISA appeals • Support billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties

🎯 Requisitos

• CPC, CCS, CPMA, or similar certification preferred, but not required • CPB certification preferred • Minimum of three years of professional healthcare revenue cycle experience • Professional experience in both medical billing and medical coding required • Experience with denial management, claims resolution, accounts receivable follow-up, appeals, or payer correspondence • Experience with Epic, Athena, NextGen, eClinicalWorks, or comparable healthcare systems • Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, medical necessity requirements, and payer reimbursement policies • Experience working with commercial insurance, Medicare, Medicaid, self-funded health plans, payer portals, and claim follow-up workflows • Ability to review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues • Strong written communication skills with experience preparing professional appeal letters • Strong analytical, organizational, and problem-solving abilities • Ability to independently manage a high-volume workload and meet payer deadlines • Proficiency in Microsoft Excel, Word, and Outlook.

🏖️ Benefícios

• Comprehensive benefits • Supportive leadership • Opportunities for professional growth • Stable, long-term employment