Team Lead

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.

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