Experienced Health Insurance Medical Coders

Job Description

Wipro is seeking dedicated and detail‑oriented specialists who possess a Medical Coding Certificate and have a strong understanding of records review specifically from the insurance provider side. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials needing E & M outpatient CPT Coding. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if conditions of coverage exist.

GMC & E&M experience required.

• 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, editing rules, clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• 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.
• Conduct research of system edits and determine claim decision on the provider dispute.
• Experience in working with various claims systems (e.g., Facets, Encoder Pro, etc).
• Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.

• Live within the Tampa Bay or Atlanta Metro area; may be required to go into the local office on occasion.
• Must be certified and a active professional coder (AAPC CPC, CEMC, COC, CIC or AHIMA CCS, CCS‑P).
• Experience with appeals and denials (NCD/LCD, Duplicate, MUE).
• 2 years of prior experience as a coder with E&M, GMC and surgical coding.
• Strong knowledge of CPT, HCPCS, ICD‑10 and CMS reimbursement guidelines.
• Minimum 3 years experience reviewing denied claims and performing coding audits in a health insurance environment.
• Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.
• Ability to interpret medical records and apply coding principles accurately.
• Facility coding experience preferred.
• Multiple specialty coding experience preferred; experience in payor insurance processes.

Mandatory

Skills:

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The expected compensation for this role ranges from $28 per hour to $29 per hour.

Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. The role is also eligible for Wipro's standard benefits, including a full range of medical and dental benefits options, disability insurance, paid time off (sick leave), and other paid and unpaid leave options.

Applicants are advised that employment in some roles may be conditioned on successful completion of a post‑offer drug screening, subject to applicable state law.

Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, 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. Applications from veterans and people with disabilities are explicitly welcome.