Job Overview:
Are you a seasoned coding expert looking for your next high-impact career move
Our premier client is hiring a skilled Medical Coder (Surgery & Revenue Cycle Specialist) to play a vital role in their revenue operations! In this dynamic position, you will drive reimbursement success by accurately coding complex surgical procedures, managing prior authorizations, and guiding billing support. We're seeking an expert with deep ASC coding knowledge (General Surgery, GI, GYN, and Ortho) alongside a strong mastery of Medicare regulations, NCCI edits, and payer guidelines.
Schedule:
Monday - Friday, 8:30 AM - 5:00 PM PST, with 30-minute unpaid break (40 work hours per week)
Responsibilities:
Medical Coding
- Review physician operative reports and medical documentation for completeness and accuracy.
- Assign accurate ICD-10-CM, CPT, HCPCS Level II, and modifier codes.
- Code surgical procedures for:General Surgery
- Gastroenterology (GI)
- Gynecology (GYN)
- Orthopedic Surgery
- Apply Medicare, commercial payer, and ASC billing guidelines.
- Ensure compliance with NCCI edits, MUEs, LCDs, and payer-specific policies.
- Identify documentation deficiencies and communicate with providers for clarification.
- Assist with coding audits and quality assurance initiatives.
Insurance Verification & Authorizations
- Verify patient insurance eligibility and benefits.
- Obtain and manage prior authorizations and referrals.
- Review payer requirements for surgical procedures.
- Confirm coverage limitations, medical necessity, and benefit availability.
- Coordinate with physician offices and insurance carriers regarding authorization status.
- Resolve authorization issues prior to scheduled procedures.
Revenue Cycle & Billing Support
- Review claims for coding accuracy prior to submission.
- Assist billing staff with coding-related claim edits and denials.
- Research denied claims and provide coding corrections when appropriate.
- Support appeals for coding and medical necessity denials.
- Ensure documentation supports billed services.
- Maintain compliance with payer regulations and reimbursement policies.
Compliance & Quality
- Maintain HIPAA compliance and patient confidentiality.
- Stay current on CPT, ICD-10, HCPCS, CMS, Medicare, and payer updates.
- Participate in continuing education and coding training.
- Assist with internal coding audits and process improvement initiatives.
Requirements:
- Minimum of 5 years of surgical coding experience.
- Experience coding in an Ambulatory Surgery Center (ASC) preferred.
- Strong knowledge of:ICD-10-CM
- CPT
- HCPCS Level II
- Modifiers
- Medicare ASC reimbursement
- NCCI edits
- LCD/NCD guidelines
- Experience with insurance verification and prior authorizations.
- Knowledge of medical billing and claims processing.
- Ability to interpret operative reports and physician documentation.
- Excellent analytical and problem-solving skills.
- Strong written and verbal communication skills.
- Ability to work independently and manage multiple priorities.
Qualifications:
- Experience with eClinicalWorks (eCW) or similar electronic health record (EHR) systems.
- Experience using clearinghouses such as Waystar or Office Ally.
- Knowledge of commercial payer policies, Medicare, Medi-Cal, and managed care organizations.
- Experience with denial management.
Independent Contractor Perks:
- Permanent work from home
- Immediate hiring
- Health Insurance Coverage for eligible locations
Note:
Please click the Apply button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.
