- Perform accurate CPT / ICD-10-CM coding with appropriate modifier usage
- Review and analyze denied claims and identify root causes
- Initiate outbound calls to provider offices for denial clarification and resolution
- Document call outcomes and update claim status in systems
- Ensure timely follow-up on pending claims to maximize reimbursement
- Adhere to client-specific guidelines and project requirements
- Maintain quality and productivity benchmarks as defined by the client
- Prepare reports and track performance using MS Excel / PPT
Responsibilities
- Perform accurate CPT / ICD-10-CM coding with appropriate modifier usage
- Review and analyze denied claims and identify root causes
- Initiate outbound calls to provider offices for denial clarification and resolution
- Document call outcomes and update claim status in systems
- Ensure timely follow-up on pending claims to maximize reimbursement
- Adhere to client-specific guidelines and project requirements
- Maintain quality and productivity benchmarks as defined by the client
- Prepare reports and track performance using MS Excel / PPT
Qualifications
Qualifications & Skills (8–10 Points)
- Denial Experience (EM + Surgery) and 3+ Years after CPC/CCS is not mandatory
- Strong knowledge of CPT, ICD-10-CM, modifiers, E&M;, and surgical coding
- Good understanding of Anatomy & Physiology
- Mandatory certification: CPC or CCS (No Apprentice credentials)
- Excellent communication skills with neutral accent (mandatory for calling role)
- Prior experience in voice process is an added advantage
- Ability to work in Eastern (US) shift
- High energy level with proactive and spontaneous approach
- Strong analytical and problem-solving skills
- Proficiency in MS Office (Excel & PowerPoint)
- Ability to understand client requirements and deliver accordingly
Telecommuting Requirement
- Must be comfortable working in a telecommuting (remote/hybrid) setup as per business requirements
- Ensure secure internet connectivity and a distraction-free work environment for both coding and calling responsibilities q