Coding Denials Auditor

Enable Comp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, Enable Comp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes.

By partnering with clients to supercharge the reimbursement process, Enable Comp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. Enable Comp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc.

5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

The Coding Denials Auditor provides analysis of coded medical services, reports, records, and billed charges, etc. to determine appropriateness of the medical coding utilized, delivery of care and treatment plans. The Coding Denials Auditor will use their expertise and coding expertise to communicate internally and externally.

• Conducts coding audits of submitted claims to determine appropriateness of procedure and diagnosis codes billed based on documentation provided for both outpatient facility and professional claims.
• Reviews Billing for accuracy to ensure compliance of proper billing and coding procedures of third-party carriers and to ensure complete and accurate reimbursement.
• Coordinates with revenue cycle teams to investigate rejected or denied claims to determine denial accuracy and work in an inter-departmental collaboration process to assist in claim corrections/appeals
• Effectively utilizes computer and appropriate software (Microsoft Office Suite) to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment, including a basic to intermediate level of competency in Excel which is required
• Maintains knowledge regarding medical coding and/or healthcare market changes.
• Gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.
• Draft appeals to payors using nationally sourced coding guidelines such as CPT Assistant, specialty societies, state fee schedule language, AAPC/AHIMA articles etc.
• Other duties as required.

• Associates or Bachelor's Degree
• Current certification in one of the following:
  Certified Professional Coder (CPC) or related certification by AAPC, Certified Coding Associate (CCA) by AHIMA, Certified Coding Specialist (CCS) by AHIMA, Registered Health Information Technician (RHIT) by AHIMA.

• The applicant must have a strong background in orthopedics and surgery billing/coding. The ideal candidate has 5+ years of experience in orthopedic surgery billing, a solid background in coding and medical billing, with special emphasis on AR, EOB's, and overall account management, including coding denials.
• Must be able to gather and analyze claims and medical records information pertinent to documentation findings and outcomes; use this information to make educated decisions.
• Must have strong written communication…