Medical Coder / Denial Specialist
Department: Back Office
Reports To: Revenue Cycle Manager
Employment Type: Full-time
Job Summary
The Medical Coder / Denial Specialist is responsible for accurate medical coding, claims review, and denial management for an ENT (Ear, Nose & Throat) clinic. This role ensures timely reimbursement by assigning correct CPT, ICD-10-CM, and HCPCS codes, identifying and resolving claim denials, and working closely with providers, billing staff, and payors to reduce revenue loss and improve claim outcomes.
Key ResponsibilitiesMedical Coding
· Review clinical documentation for ENT office visits, procedures, surgeries, audiology services, and ancillary services
· Accurately assign CPT, ICD-10-CM, and HCPCS codes in compliance with payer and regulatory guidelines
· Ensure proper use of modifiers (e.g., -25, -50, RT/LT, -59) specific to ENT coding
· Verify medical necessity and coding specificity prior to claim submission
· Maintain up-to-date knowledge of ENT-specific coding and payer rules
Denial Management
· Analyze and work denied and underpaid claims in a timely manner
· Identify denial trends and root causes and recommend corrective actions
· Prepare and submit corrected claims and formal appeals with supporting documentation
· Track appeal outcomes and follow up with insurance companies as needed
· Communicate recurring denial issues to billing staff and providers
Compliance & Quality
· Ensure compliance with CMS, payer contracts, and clinic policies
· Support internal and external audits by providing documentation and coding rationale
· Maintain HIPAA compliance and patient confidentiality at all times
Collaboration & Communication
· Work closely with providers to clarify documentation and improve coding accuracy
· Collaborate with front desk, billing, and authorization teams to prevent denials
· Educate staff on common ENT coding and denial issues as needed
Required Qualifications
· High school diploma or equivalent (Associate’s degree preferred)
· Certified Professional Coder (CPC), CCS, or equivalent certification required
· 2+ years of medical coding experience, preferably in ENT, surgical specialties, or multi-specialty practices
· Strong knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage
· Experience working insurance denials and appeals
Preferred Qualifications
· Prior experience in an ENT or otolaryngology clinic
· Familiarity with audiology and hearing aid coding
· Knowledge of common ENT procedures (e.g., nasal endoscopy, laryngoscopy, sinus surgery, tonsillectomy, ear procedures)
· Experience with EHR and practice management systems
· Understanding of prior authorizations and medical necessity guidelines
Skills & Competencies
· Strong attention to detail and accuracy
· Excellent analytical and problem-solving skills
· Effective written and verbal communication
· Ability to manage multiple priorities and meet deadlines
· Independent work style with strong follow-through
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
People with a criminal record are encouraged to apply
Work Location: In person
