Immediate need for a talented Team Lead . This is a Fulltime opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-02893
Pay Range: $90,000 - $100,000/annum. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- NOTE : We need local candidate from Tampa Bay or Atlanta Metro area
- Review adjudicated medical claims denied and resubmitted for reconsideration
- Review medical documentation supporting Evaluation & Management (E&M) services in compliance with CPT, HCPCS, ICD-10, CMS, and payer-specific policies
- Analyze claim documentation, coding accuracy, and medical records to validate denial reasons or payment reconsideration
- Conduct detailed coding audits to ensure medical necessity and regulatory compliance
- Research and respond to appeals, system inquiries, and adjudication issues
- Perform claims system research (Facets, Encoder Pro, or similar) to audit adjudication accuracy
- Prepare clear documentation outlining findings, corrections, and claim outcome recommendations
- Supervise and lead a team of 15 medical coders specializing in GMC & E&M
- Assign, monitor, and review coding work for accuracy, timeliness, and compliance
- Conduct regular quality audits and provide coder feedback
- Act as SME for 1995/1997 E&M guidelines and 2021 AMA/CMS updates
- Collaborate with providers, auditors, and compliance teams to resolve discrepancies
- Develop and deliver training programs for GMC & E&M coding updates
- Track productivity, generate performance reports, and support workforce initiatives
- Support medical necessity and revenue integrity initiatives
Key Requirements and Technology Experience:
- Must have skills: - ["GMC & E&M Coding", "Denied Claims Review", "Appeals & Reconsiderations", "CPT / HCPCS / ICD-10", "CMS & Payer Guidelines", "Coding Audits", "Revenue Integrity", "Team Leadership", "Facets / Encoder Pro"].
- Active CPC, CCS, or equivalent certification (Mandatory)
- 5 years of GMC & E&M coding experience (Mandatory)
- 5 years in a leadership role managing coding teams
- 3 years reviewing denied claims and performing coding audits
- Strong experience with appeals & denials (NCD/LCD, Duplicate, MUE)
- Mandatory experience with payer insurance processes
- Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines
- Experience working with claims systems (Facets, Encoder Pro, etc.)
- Excellent analytical, communication, and documentation skills
- Ability to work independently in a fast-paced environment
- Proven experience as a Coding Lead, Quality Reviewer, or SME
Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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