Coding Suspends Senior Specialist

Accountabilities In this role, you will oversee the investigation and resolution of coding-related suspends, helping ensure accurate claim submissions and consistent compliance with healthcare coding requirements. Your responsibilities will include:

• Review and analyze coding-related suspends generated by coding software and systems, identifying errors, discrepancies, and missing information.

• Examine medical records, encounter forms, and supporting documentation to validate code assignments and ensure compliance with applicable guidelines and regulations.

• Research and interpret CPT, ICD-10, HCPCS, and payer-specific coding requirements to accurately assign and sequence diagnosis and procedure codes.

• Collaborate with coding and billing teams, clinicians, and other stakeholders to obtain additional information, clarify documentation, and resolve coding issues.

• Correct code assignments, modifiers, and other coding elements to address suspends and support accurate claim submission.

• Maintain detailed and accurate records of coding activities, findings, and resolutions within relevant software and systems.

• Identify coding trends and recurring issues, sharing best practices and providing guidance, training, and support to improve accuracy and compliance.

• Monitor updates to coding guidelines, regulations, and payer policies, implementing necessary changes to maintain compliance.

• Support coding audits, reviews, and compliance initiatives by identifying errors, patterns, and opportunities for improvement.

• Participate in coding-related meetings, committees, and projects, contributing expertise to strengthen coding and billing operations.

Requirements :

The ideal candidate combines hands-on medical coding experience with strong analytical skills, attention to detail, and a thorough understanding of healthcare coding standards. The following qualifications and competencies are required:

• Bachelor's degree in a Life Science field.

• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or an equivalent relevant coding certification.

• 2–3 years of experience in medical coding, preferably with a focus on coding suspends and denials.

• In-depth knowledge of CPT, ICD-10, HCPCS, and other relevant medical coding systems and guidelines.

• Familiarity with coding software and tools, including encoders, grouper software, and Electronic Health Record (EHR) systems.

• Strong analytical and problem-solving abilities, with the capacity to investigate and resolve complex coding discrepancies.

• Excellent attention to detail and accuracy, with a commitment to maintaining high coding standards and regulatory compliance.

• Strong written and verbal communication skills, with the ability to collaborate effectively across multidisciplinary teams.

• Proficiency in medical terminology, anatomy, physiology, and disease processes.

• Ability to work independently, manage priorities, and meet deadlines in a fast-paced healthcare environment.

• Commitment to continuous learning and staying informed about coding regulations, industry developments, and best practices.

Benefits :

• Base compensation determined by geographic location, skills, experience, qualifications, and other job-related factors.

• Eligibility for a discretionary performance-based incentive bonus.

• Participation in a performance-based rewards and recognition program.

• Employee referral bonus opportunities.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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