Medical Coder GluCare

Core Responsibilities

• Review patient medical records, including physician notes, test results, charge tickets, and other documentation from outpatient encounters.
• Ensure coding reflects medical necessity and supports billed services.
• Clarify incomplete or ambiguous documentation with clinicians.
• Apply payer specific coding guidelines and bundling rules.
• Assist with audits, denial management, education to providers on documentation best practices, and reimbursement questions.
• Submission of Clean claims to insurance within the defined TAT.
• Resubmission of partially rejected claims with justification within defined TAT time.

Denial Analysis and Resubmissions

• Review rejected and denied claims to identify root causes.
• Correct coding errors and prepare compliant resubmissions; Draft appeal letters with clinical justification and supporting documents, Track resubmission outcomes and escalate unresolved cases.

Documentation Integrity

• Ensure clinical notes, diagnostic reports, and orders support coded services.
• Validate alignment between coding, authorization, and billed services.
• Maintain organized digital records of denials, corrections, and appeals.

Payer and TPA Coordination

• Liaise with insurance companies and TPAs to clarify denial reasons.
• Communicate resubmission status to billing, approvals team, and management.
• Monitor payer policy updates and adjust coding practices accordingly.

Systems and Reporting

• Use HIS, EclaimLink, and payer portals to manage coding edits and resubmissions.
• Recommend process improvements to reduce recurring denials.