Roles &

- Responsibilities An Edits &
- Denials Medical Coder is responsible for reviewing, analyzing, correcting, and resolving coding-related claim edits and denials to ensure accurate reimbursement and compliance with payer regulations. This role serves as a critical link between Coding, Billing, Revenue Cycle, and Payer Operations.

Key Responsibilities

1. Denial Management

- Review and analyze denied medical claims to identify the root cause.

- Resolve coding-related denials from Medicare, Medicaid, and commercial payers.

- Correct diagnosis, procedure, modifier, and billing errors leading to denials.

- Prepare and submit claim corrections and rebills as required.

- Track denial trends and recommend preventive actions.

1. Claim Edit Resolution

- Review front-end and back-end claim edits before claim submission.

- Resolve coding, demographic, authorization, and medical necessity edits.

- Ensure claims pass payer-specific and clearinghouse edits.

- Work on National Correct Coding Initiative (NCCI) and payer edit resolutions.

1. Coding Review &
- Correction

- Review medical records to validate diagnosis and procedure coding.

- Ensure proper assignment of ICD-10-CM, CPT, HCPCS, and modifiers.

- Identify undercoding, overcoding, and missed charges.

- Correct coding discrepancies to support accurate reimbursement.

1. Appeals &
- Reconsiderations

- Prepare and submit appeal documentation for denied claims.

- Draft coding rationales and supporting documentation for appeal requests.

- Collaborate with providers and clinical departments to obtain additional documentation.

- Monitor appeal outcomes and maintain appeal records.

1. Compliance &
- Regulatory Adherence

- Ensure compliance with CMS, HIPAA, Medicare, Medicaid, and payer-specific guidelines.

- Follow AHIMA, AAPC, ICD-10-CM, CPT, and HCPCS coding standards.

- Maintain audit-ready documentation and coding practices.





- Participate in compliance audits and quality reviews.

1. Denial Trend Analysis

- Analyze recurring denial patterns and identify root causes.

- Generate denial reports and performance dashboards.

- Recommend process improvements to reduce future denials.

- Support revenue cycle initiatives to improve clean claim rates.

1. Collaboration &
- Stakeholder Management

- Work closely with Coding, Billing, CDI, Revenue Cycle, and Provider teams.

- Communicate denial findings and corrective actions to relevant stakeholders.

- Assist in educating staff on documentation and coding requirements.

- Support process improvement and workflow optimization projects.

1. Quality Assurance

- Perform quality checks on corrected claims and appeal submissions.

- Maintain productivity and accuracy standards.

- Ensure timely resolution of edits and denials according to established TATs.

- Monitor key denial and recovery metrics.

1. Continuous Learning

- Stay current on ICD-10-CM, CPT, HCPCS, and payer policy updates.

- Attend coding, compliance, and denial management training sessions.

- Maintain coding certifications and continuing education requirements.

Required Skills

- Solid knowledge of ICD-10-CM, CPT, HCPCS, and modifier assignment.

- Understanding of payer guidelines and denial management processes.

- Knowledge of Medicare, Medicaid, and commercial insurance policies.

- Strong analytical and problem-solving skills.

- Experience with EHR/EMR systems, encoder tools, and claim processing platforms.

- Ability to interpret EOBs, remittance advice, and denial codes.

Preferred Qualifications

- CPC, CCS, CRC, CIC, COC, or equivalent coding certification.

- Experience in Medical Coding, Revenue Cycle Management, or Denials Management.

- Knowledge of payer appeals and reimbursement methodologies.

Interested candidates can call to HR Harshita - (phone hidden) &

- HR Ranu - (phone hidden)

📌 Edits & Denials Medical Coder (Noida)
🏢 CorroHealth
📍 Noida