Experienced Health Insurance Medical Coders

Position Overview

Job Title: Experienced Health Insurance Medical Coders.Location: Atlanta, Tampa, California, Florida.Compensation: $28 per hour to $29 per hour.
Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. In this role, you will handle appeals for Medicare members with emphasis on NCD/LCD, Duplicate, and MUE denials needing E & M outpatient CPT Coding. You will review medical records, compare findings to CMS guidelines, and determine if conditions of coverage exist.

Responsibilities:

• Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies and editing rules, including conducting clinical research and data analysis.
• Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.
• Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.
• Coordinate research and respond to system inquiries and appeals.
• Research system edits and make determinations on claim decisions for provider disputes.
• Work within various claims systems (e.g., Facets, Encoder Pro, etc.).
• Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.

Required Qualifications

• Live within the Tampa Bay or Atlanta Metro area; occasional in-office presence may be required.
• MUST be a Certified & active Professional Coder (AAPC: CPC, CEMC, COC, CIC or AHIMA: CCS, CCS-P).
• Experience with appeals and denials (NCD/LCD, Duplicate, MUE) is required.
• A minimum of 2 years prior experience as a coder with E&M, GMC, and surgical coding.
• Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.
• At least 3 years of experience reviewing denied claims and performing coding audits in a health insurance environment.
• Excellent analytical, communication, and documentation skills with strong attention to detail.
• Ability to interpret medical records and apply coding principles accurately.
• Mandatory Skills: Claims_Processing.

Preferred Qualifications

• Facility coding experience.
• Multiple specialty coding experience, particularly in payor insurance processes.

Benefits:

• Eligibility for Wipro's standard benefits, including a full range of medical and dental options.
• Disability insurance and paid time off (inclusive of sick leave).
• Other paid and unpaid leave options.