Certified Coding Escalation Specialist

Job Summary

Handling complex coding issues in a full-time remote capacity, the Certified Coding Escalation Specialist will resolve escalations, conduct thorough reviews of medical records, and provide expert support to the medical coding team while ensuring compliance with regulatory requirements.

Key responsibilities

• Review and resolve escalated coding issues from coders, auditors, and billing teams
• Analyze medical records to ensure accurate and compliant code assignment
• Educate and mentor coding staff on complex cases and updates to coding regulations

Required qualifications

• Minimum 3-5 years of experience in medical coding, focusing on complex case review or coding quality assurance
• AAPC or AHIMA certification is required
• Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems
• Strong understanding of CMS regulations and payer-specific guidelines
• Experience with electronic health records (EHRs) and coding software systems