code edit cum caller responsible for medical coding and telephonic interaction with provider offices to resolve claim denials. The role requires strong coding expertise along with effective communication skills to ensure timely claim resolution. The candidate must balance accuracy, productivity, and client communication while adhering to quality standards.
Job Description :
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 & Skills :
Solid 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 workplace for both coding and calling responsibilities