Team Lead

Immediate need for a talented Team Lead . This is a Fulltime opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-02893

Pay Range: $90,000 - $100,000/annum. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

NOTE : We need local candidate from Tampa Bay or Atlanta Metro area

Review adjudicated medical claims denied and resubmitted for reconsideration

Review medical documentation supporting Evaluation & Management (E&M) services in compliance with CPT, HCPCS, ICD-10, CMS, and payer-specific policies

Analyze claim documentation, coding accuracy, and medical records to validate denial reasons or payment reconsideration

Conduct detailed coding audits to ensure medical necessity and regulatory compliance

Research and respond to appeals, system inquiries, and adjudication issues

Perform claims system research (Facets, Encoder Pro, or similar) to audit adjudication accuracy

Prepare clear documentation outlining findings, corrections, and claim outcome recommendations

Supervise and lead a team of 15 medical coders specializing in GMC & E&M

Assign, monitor, and review coding work for accuracy, timeliness, and compliance

Conduct regular quality audits and provide coder feedback

Act as SME for 1995/1997 E&M guidelines and 2021 AMA/CMS updates

Collaborate with providers, auditors, and compliance teams to resolve discrepancies

Develop and deliver training programs for GMC & E&M coding updates

Track productivity, generate performance reports, and support workforce initiatives

Support medical necessity and revenue integrity initiativesKey Requirements and Technology Experience:

Must have skills: - ["GMC & E&M Coding", "Denied Claims Review", "Appeals & Reconsiderations", "CPT / HCPCS / ICD-10", "CMS & Payer Guidelines", "Coding Audits", "Revenue Integrity", "Team Leadership", "Facets / Encoder Pro"].

Active CPC, CCS, or equivalent certification (Mandatory)

5 years of GMC & E&M coding experience (Mandatory)

5 years in a leadership role managing coding teams

3 years reviewing denied claims and performing coding audits

Strong experience with appeals & denials (NCD/LCD, Duplicate, MUE)

Mandatory experience with payer insurance processes

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

Experience working with claims systems (Facets, Encoder Pro, etc.)

Excellent analytical, communication, and documentation skills

Ability to work independently in a fast-paced environment

Proven experience as a Coding Lead, Quality Reviewer, or SMEOur client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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