Coding Escalation Specialist, Pro Fee Hospital

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Ventra Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2021

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Ventra Health is a healthcare revenue cycle management (RCM) company that provides end-to-end medical billing, coding, claims management, denial prevention, payer contracting, and collections services for hospitals, health systems, and physician practices across the U. S. Its offerings combine domain expertise and white‑glove client service with proprietary data and AI-powered platforms—vCision (AI & automation) and vSight (data & analytics)—to improve reimbursement, reduce denials, accelerate cash collections, and deliver measurable RCM performance improvements. Ventra emphasizes enterprise service delivery, provider education, compliance and coding audits, patient responsibility management, and payer strategy, serving thousands of providers and facilities nationwide.

📋 Description

• Review and resolve escalated coding issues from coders, auditors, billing teams, and providers • Analyze medical records and documentation to ensure accurate and compliant code assignment • Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules • Identify coding trends, discrepancies, and compliance risks; recommend corrective actions • Participate in coding audits and assist in implementing audit recommendations • Educate and mentor coding staff on complex cases and updates to coding regulations

🎯 Requirements

• Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance • AAPC or AHIMA certification required • Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems • Strong understanding of CMS regulations and payer-specific guidelines • Excellent analytical, problem-solving, and decision-making skills • Experience with electronic health records (EHRs) and coding software systems

🏖️ Benefits

• Ventra performance-based incentive plan • Referral bonus