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Healthcare Legal Solutions, LLC

Coding Specialist

Washington, District of Columbia, United States · On-site

$25/hr–$30/hr

Mid level

Description Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support our end‑to‑end appeals and claims recovery operations. This role will be responsible for ensuring that coding applied t…

Skills: Medical Coding, ICD-10, CPT, HCPCS, Denial Management

Coding Specialist

Healthcare Legal Solutions, LLC

Washington, District of Columbia, United States • On-site

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Mid level

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  • $25/hr–$30/hr
  • Full-time
  • high school, associate degree, bachelor degree, professional certificate
  • Posted 18d ago
  • ~40 hrs/week

Responsibilities

The Senior Coding Specialist reviews complex denied and underpaid claims to ensure accurate coding and strategic alignment for appeals. They analyze medical records and payer policies to identify coding gaps and recommend corrective actions to improve recovery outcomes.

Requirements

Candidates must have a CPC certification and at least 3 years of hands-on medical coding experience with proficiency in ICD-10, CPT, and HCPCS. An associate or bachelor's degree is preferred, along with experience in healthcare legal or revenue cycle operations.

Full job description

Description 
Healthcare Legal Solutions is seeking an experienced Senior Coding Specialist to support our end‑to‑end appeals and claims recovery operations. This role will be responsible for ensuring that coding applied to denied and appealed claims is accurate, compliant, and strategically aligned with payer requirements and client expectations. Rather than simply coding high‑volume encounters, this position will focus on reviewing complex claims, interpreting documentation and payer policies, advising on appeal strategy, and supporting quality and consistency across our coding and denial management workflows.

The Senior Coding Specialist will have visibility across multiple product lines and venues, including inpatient and outpatient hospital claims, professional services, and specialty service lines, as applicable to client engagements. They will help operationalize coding guidelines, regulatory requirements, and client policies; identify coding‑related denial trends; recommend corrective actions; and contribute to process improvements that enhance both recovery outcomes and compliance. This role may also provide guidance and education to internal staff and client teams on documentation standards, coding changes, and payer expectations.

Key Responsibilities

  • Review codes already billed based on APR‑DRG and MS‑DRG for appeal.
  • Review denied and underpaid claims to confirm and assignappropriate ICD‑10, CPT, HCPCScodesand modifiers, ensuring coding supports appeal arguments andcomplies withpayer and regulatory guidelines.
  • Analyze medical records, EOBs, denial and approval letters, and related correspondence toidentifycoding issues, documentation gaps, and opportunities to overturn denials.
  • Interpret and apply Medicare, Medicaid, and commercial payer rules and policies, including NCCI edits and medical necessity requirements, within the appeals and claims recovery process.
  • Collaborate with appeals specialists, legal and clinical reviewers, and client revenue cycle teams to clarify documentation, resolve coding questions, and support case strategy.
  • Monitorcoding‑relateddenial trends,assistinroot‑causeanalysis, and recommend process or documentation changes to reduce future denials.
  • Support the development and maintenance of standardized coding procedures, guidelines, and templates in alignment with regulatory requirements and client policies.
  • Provide input into operational and performance reports related to coding accuracy, denial overturn rates, and documentation quality.
  • Participate in audits and quality reviews;identifycoding or documentation errors and contribute tocorrective‑actionplans.
  • Assistwith onboarding and ongoing training of team members on coding fundamentals, documentation expectations, and relevant policy or regulatory updates.

Qualifications

  • Associate or bachelor’s degree in a related field preferred; candidates with a high school diploma/GED and strong relevant experience will be considered.
  • Current CPC (Certified Professional Coder) or equivalent coding certification required;additionalcertifications (e.g., CCS, CRC/Risk Adjustment) are preferred.
  • Prior experience with health systems, health plans, TPAs, or healthcare legal/consulting organizations, specifically in Coding, Denials/Appeals, or Revenue Cycle Operations.
  • Minimum3years of handson medical coding experience, withdemonstratedproficiencyinICD10, CPT, HCPCS, and modifier use.
  • Familiarity with Medicare and commercial payer regulations, documentation requirements, and third‑party payer issues.
  • Strong analytical skills with the ability to synthesize documentation, denial codes, and payer policies into clear coding and appeal recommendations.
  • Excellent written and verbal communication skills, with the ability to explain coding decisions and documentation needs to both technical and non‑technical stakeholders.
  • Strong organizational and time‑management skills, with the ability to manage multiple priorities, deadlines, and stakeholders in a fast‑paced, metrics‑driven environment.

Fast learners with solid foundational experience in coding, denials, or healthcare operations are encouraged to apply.

Related keywords

APR-DRGMS-DRGICD-10CPTHCPCSCPCCCSCRCRisk AdjustmentNCCI EditsMedicareMedicaidMedical NecessityEOBRevenue CycleDenial Trends

About Healthcare Legal Solutions, LLC

LinkedInVisit site

HLS submits appeals for denied, complex, and underpaid hospital claims so providers can maximize reimbursement.

Industry
Legal Services
Company size
11-50 employees
Founded
2003
Headquarters
Washington, DC
LinkedIn followers
595

Healthcare Legal Solutions, LLC, (“HLS”) is a legal collections firm specializing in third party payer collections for hospitals and health systems. We resolve third party problematic -- delayed, denied or underpaid -- claims from payers such as Medicare, Medicaid, MCOs, Commercial, Blue Cross, employers groups with ERISA plans and others. We set up appeals and intensive follow-up programs to supplement the efforts of hospital revenue cycle and case management departments. HLS specializes in the collection of older receivables which may require a specialized legal skillset. This specialization translates in superior collections from 30-60% of net additional revenue over in-house and industry standard bad-debt processes.

Offices: 2001 Pennsylvania Avenue, NW, Suite 750, Washington, DC 20006, US

Healthcare reimbursementInsurance and commercial payer reimbursementMedicare and Medicaid Appealsand ERISA appeals
View all jobs at Healthcare Legal Solutions, LLC

About Healthcare Legal Solutions, LLC

LinkedInVisit site

HLS submits appeals for denied, complex, and underpaid hospital claims so providers can maximize reimbursement.

Industry
Legal Services
Company size
11-50 employees
Founded
2003
Headquarters
Washington, DC
LinkedIn followers
595

Healthcare Legal Solutions, LLC, (“HLS”) is a legal collections firm specializing in third party payer collections for hospitals and health systems. We resolve third party problematic -- delayed, denied or underpaid -- claims from payers such as Medicare, Medicaid, MCOs, Commercial, Blue Cross, employers groups with ERISA plans and others. We set up appeals and intensive follow-up programs to supplement the efforts of hospital revenue cycle and case management departments. HLS specializes in the collection of older receivables which may require a specialized legal skillset. This specialization translates in superior collections from 30-60% of net additional revenue over in-house and industry standard bad-debt processes.

Offices: 2001 Pennsylvania Avenue, NW, Suite 750, Washington, DC 20006, US

Healthcare reimbursementInsurance and commercial payer reimbursementMedicare and Medicaid Appealsand ERISA appeals
View all jobs at Healthcare Legal Solutions, LLC

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