Job Description

Position: Medical Coder

Job-Type: Full-time/permanent

Location: Tampa, FL and Atlanta, GA - Remote ( After the 3-week training in the office, the position is remote)

Job Description

Our team is seeking dedicated and detail-oriented specialists who possess a Medical Coding Certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if conditions of coverage exist. If conditions are not met, the specialist will provide an uphold justification.

Key Responsibilities:

• Review and analyze medical records for Medicare appeals.
• Work on NCD/LCD denials, Duplicate denials, and MUE denials.
• Compare medical findings to CMS guidelines.
• Determine if conditions of coverage are met.
• Provide uphold justifications when conditions of coverage are not met.
• Maintain accurate and detailed documentation of all reviews and decisions.
• Communicate effectively with team members and other stakeholders.
• Stay updated with CMS guidelines and changes in Medicare policies.
• Initially focus on FACETS cases, with plans to expand to COSMOS cases.
• Handle additional coding-related scenarios as the team expands.

Basic Requirements:

• High School or equivalent - Document will be required, so please ask if they have a hard copy available.
• Previous WFH experience with high-speed internet.
• Coding certificate (CPC, CCS, or equivalent).
• Strong understanding of medical records review.
• Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE).
• Experience with FACETS (required).
• Able to work in-office during 3-week training.
• Must have experience with denied claims review as an auditor/examiner. (Note: It is more of a back-office data processing position rather than a call center/customer service job).

Preferred:

• Experience with COSMOS (secondary).
• Previous experience in a similar role.
• Knowledge of healthcare regulations and compliance.

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