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Coding Escalation Specialist – Pro Fee Hospital
Medsuite IncMedical Coding Escalation Specialist at Ventra Health resolving complex coding issues in healthcare. Ensuring compliance and supporting coding staff while maintaining regulatory standards.
About the role
Key responsibilities & impact- Review and resolve escalated coding issues from coders, auditors, billing teams, and providers
- Analyze medical records and documentation to ensure accurate and compliant code assignment
- Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules
- Identify coding trends, discrepancies, and compliance risks; recommend corrective actions
- Participate in coding audits and assist in implementing audit recommendations
- Educate and mentor coding staff on complex cases and updates to coding regulations
- Ensure adherence to all applicable coding standards (CMS, AHA Coding Clinic, AMA CPT Assistant)
- Support continuous improvement initiatives in coding accuracy, workflow, and documentation quality
- Maintain up-to-date knowledge of coding updates, regulatory changes, and payer guidelines
Requirements
What you’ll need- Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance
- AAPC or AHIMA certification required
- Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems
- Strong understanding of CMS regulations and payer-specific guidelines
- Excellent analytical, problem-solving, and decision-making skills
- Effective communication and interpersonal skills
- Ability to work independently and manage multiple priorities in a fast-paced environment
- Experience with electronic health records (EHRs) and coding software systems
- Ability to read, understand, and apply state/federal laws, regulations, and policies
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner
- Basic use of computer, telephone, internet, copier, fax, and scanner
- Basic touch 10 key skills
- Basic Math skills
- Understand and comply with company policies and procedures
- Strong oral, written, and interpersonal communication skills
- Strong time management and organizational skills
- Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills
Benefits
Comp & perks- health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development
- bonuses
- performance-based incentive plan
- referral bonus
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills & Tools
Medical CodingCoding Quality AssuranceCoding AuditsRegulatory ComplianceCoding GuidelinesData AnalysisProblem-SolvingDecision-MakingElectronic Health Records (EHRs)Coding Software Systems
Soft Skills
Effective CommunicationInterpersonal SkillsTime ManagementOrganizational SkillsMentoring
Certifications
AAPC CertificationAHIMA Certification