Analyst, Pre-Pay Dispute Coding (Remote)

Investigate and resolve disputes related to provider appeals by systematically examining medical records, denial reasons, and claim history to determine if documentation substantiates rendered services. Conduct independent audits of non-medical records to verify billing accuracy, making decisions within designated authority to either overturn or uphold denials in a timely manner. Generate communication determinations to providers using appropriate letter language and provide necessary guideline links. Identify and document coding errors or inconsistencies, collaborating with internal departments to track issues for precise code editing and compliance. Complete data points within internal applications to meet auditing requirements while actively participating in process enhancements to maintain alignment with current coding regulations. Requires at least two years of medical coding or billing experience and an active CPC or CCS certification.