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Coding Escalation Specialist- Pro Fee Hospital

Ventra Health, Inc. -
Remote

Apply Now

Job Details

Full-time

Benefits

Referral program

Qualifications

Quality control corrective actions
Compliance risk assessment
Microsoft Outlook
Computer literacy
Spreadsheets
Copy machines
Basic math
CMS
AHIMA
Healthcare documentation compliance audits
Mid-level
3 years
CMS regulatory compliance
Quality assurance audits
Retrospective medical coding audits
Medicare regulations
Continuous improvement
Fax machines
Decision making
Clinical information systems
User support
Mentoring
Organizational skills
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical documentation improvement
10 key typing
Quality audits
Regulatory compliance analysis
Clinical documentation standards
Faxing

Full Job Description

About Us:

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards

Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary:

The Medical Coding Escalation Specialist is responsible for handling complex coding issues, resolving coding-related escalations, and providing expert-level support to the medical coding team. This role involves conducting thorough reviews of medical records, ensuring accurate code assignment, and serving as a liaison between coders, auditors, providers, and compliance teams. The specialist ensures coding practices adhere to regulatory requirements, payer policies, and internal standards.

Essential Functions and Tasks:

Review and resolve escalated coding issues from coders, auditors, billing teams, and providers.
Analyze medical records and documentation to ensure accurate and compliant code assignment
Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules.
Identify coding trends, discrepancies, and compliance risks; recommend corrective actions.
Participate in coding audits and assist in implementing audit recommendations.
Educate and mentor coding staff on complex cases and updates to coding regulations.
Ensure adherence to all applicable coding standards (CMS, AHA Coding Clinic, AMA CPT Assistant).
Support continuous improvement initiatives in coding accuracy, workflow, and documentation quality.
Maintain up-to-date knowledge of coding updates, regulatory changes, and payer guidelines.

Education and Experience Requirements:

Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance.
AAPC or AHIMA certification required.

Knowledge, Skills, and Abilities:

Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
Strong understanding of CMS regulations and payer-specific guidelines.
Excellent analytical, problem-solving, and decision-making skills.
Effective communication and interpersonal skills.
Ability to work independently and manage multiple priorities in a fast-paced environment.
Experience with electronic health records (EHRs) and coding software systems.
Ability to read, understand, and apply state/federal laws, regulations, and policies.
Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
Ability to remain flexible and work within a collaborative and fast paced environment.
Basic use of computer, telephone, internet, copier, fax, and scanner.
Basic touch 10 key skills.
Basic Math skills.
Understand and comply with company policies and procedures.
Strong oral, written, and interpersonal communication skills.
Strong time management and organizational skills.
Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Compensation:

Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health:

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [email protected] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.

Statement of Accessibility
Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.

Apply Now

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