Medical Coder

Job Tittle: Medical Coder

Job Location: Remote

Pay Rate: $29 Per hour.

Job Description Medical Coder (E/M & Claims Review)

Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration.

Review medical documentation supporting Evaluation and Management (E/M) services in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as internal reimbursement policies, competitor medical policies, reimbursement rules, and claim editing standards.

Conduct clinical research, data analysis, and identify legislative mandates to support the development and/or revision of enterprise reimbursement policies.

Analyze claim documentation, coding accuracy, and medical record details to determine the validity of denial reasons or eligibility for payment reconsideration.

Perform detailed coding audits to validate appropriate code assignment and compliance with medical necessity and billing regulations.

Coordinate research and respond to system inquiries and provider appeals.

Research claims systems and system edits to identify adjudication issues and audit claims processing accuracy.

Utilize claims systems (e.g., Facets, Encoder Pro, or similar tools) to investigate adjudication outcomes and coding accuracy.

Prepare clear, concise documentation outlining findings, coding corrections, and recommendations for claim resolution.

Mandatory experience with payer insurance processes. Qualifications

Active certification as a Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required.

Experience handling appeals and denials, including NCD/LCD, duplicate claims, and MUE edits.

2 3 years of prior Evaluation & Management (E/M) and General Medical Coding (GMC) experience.

Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.

Minimum of 3 years experience reviewing denied claims and performing coding audits in a healthcare or insurance environment.

Excellent analytical, communication, and documentation skills with strong attention to detail.

Proven ability to interpret medical records and apply coding principles accurately.

Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.