Analyst, Pre-Pay Dispute Coding (Remote)

About Our Client:
The organization operates within the healthcare sector, focusing on managing provider claims and ensuring adherence to billing standards and regulations. It addresses challenges related to claim denials and provider disputes by implementing systematic review processes and compliance with state and federal guidelines.
About the Opportunity:
The ANALYST, PRE-PAY DISPUTE CODING is responsible for supporting provider denial coding dispute activities. This role investigates and resolves disputes related to provider appeals, ensuring claims meet correct billing standards and regulatory requirements. The position contributes by improving accuracy in claim processing and supporting compliance efforts.
Responsibilities:
Review coding-related provider claim denials by examining medical records, denial reasons, submitted claims, and claim history according to applicable guidelines and protocols.
Conduct independent audits of non-medical records to verify billing accuracy and decide to overturn or uphold denials within designated authority.
Communicate determinations to providers using appropriate letter language and provide necessary guideline references.
Identify, document, and communicate coding errors or inconsistencies; collaborate with internal departments to track issues and ensure code editing and compliance.
Complete data entry within internal applications to meet auditing requirements.
Participate in process improvements to maintain alignment with current coding regulations and enhance internal procedures.
Requirements:
Minimum of 2 years of experience in medical coding or billing, or equivalent relevant education and experience.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
Strong attention to detail with the ability to independently read and understand medical records.
Ability to perform in a production-focused environment with high quality standards.
Capacity to work collaboratively within a matrixed organization.
Effective verbal and written communication skills.
Proficiency in Microsoft Office suite and applicable software programs.
Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes