Coding Denials Auditor

🔥 17 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2022-07

Consulting • Insurance • Logistics

EnableComp is a company that specializes in revenue cycle management (RCM) for healthcare providers and health systems across the United States. They focus on processing complex claims related to Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid, as well as denial management for all payer classes. By leveraging intelligent automation and their proprietary E360 RCM™ platform, EnableComp helps healthcare providers increase revenue, control costs, and streamline billing processes. With expertise in handling complex claims, the company ensures accurate and timely reimbursement, providing significant uplift to collections and improving the financial performance of its clients.

📋 Description

• Conduct coding audits of submitted outpatient facility and professional claims • Review billing accuracy and compliance with third-party carrier billing and coding procedures • Coordinate with revenue cycle teams to investigate rejected or denied claims • Assist with claim corrections and appeals through inter-departmental collaboration • Use Microsoft Office Suite to produce correspondence, charts, spreadsheets, and related information • Maintain knowledge of medical coding and healthcare market changes • Gather and analyze claims and medical records information to assess documentation findings and outcomes • Draft payer appeals using nationally sourced coding guidelines • Communicate coding expertise and audit outcomes internally and externally • Perform other duties as required

🎯 Requirements

• Associate's or Bachelor's Degree • Current certification: CPC, AAPC-related certification, CCA, CCS, or RHIT • Strong background in orthopedics and surgery billing/coding • Ideal candidate has 5+ years of orthopedic surgery billing experience • Background in coding and medical billing, including AR, EOBs, account management, and coding denials • Ability to gather and analyze claims and medical records information • Strong written communication skills • Ability to draft grammatically correct appeals using CPT Assistant, specialty society guidance, state fee schedules, and AAPC/AHIMA articles • Sound time management and ability to manage workload independently • Strong analytical, problem-solving, research, and creative-thinking skills • Comfort with CAC/Encoder audits and identifying appropriate code selection • Equivalent combination of education and experience considered • Ability to work remotely • Strong computer proficiency, including Microsoft Word, Excel, and Outlook • Regular and predictable attendance • Familiarity with healthcare documentation systems • Experience with DRGs, APCs, and NCCI fee schedule concepts • Strong verbal, written, interpersonal communication, and customer service skills • Ability to communicate audit outcomes and testing results to medically and non-medically oriented staff • Ability to interpret policies and procedures and communicate complex topics • Ability to think critically and make decisions within role responsibilities • Complex Claims medical billing and coding experience strongly preferred

🏖️ Benefits

• Professional growth and development opportunities • Tools, resources, and support for career development • Flexible, family-oriented work culture • Work-life balance support • Remote work option