Claims Resolution Coder

Sentara Health is seeking a Claims Resolution Coder to join our team in a remote capacity. As a Claims Resolution Coder, you will review medical documentation, assign accurate modifiers, and resolve insurance claim issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), and other payer-specific guidelines. This role works closely with coding, billing, and reimbursement staff to ensure accurate claims, support training, and improve coding quality.

Why Join as a Claims Resolution Coder?

A career as a Claims Resolution Coder offers the opportunity to impact revenue cycle integrity while ensuring compliance with coding standards. At Sentara Health, you’ll play a key role in clean claim submissions, identifying root causes of errors, and collaborating with staff to improve documentation practices. This position provides excellent growth potential, competitive compensation, and outstanding employee benefits.

Key Responsibilities of a Claims Resolution Coder

• Review and assign CPT, HCPCS modifiers, and revenue codes for claims.

• Resolve edits flagged by NCCI, OCE, and third-party payer systems.

• Collaborate with billing, coding, and reimbursement teams to ensure accuracy.

• Research regulations and ensure compliance with Medicare NOD and LCD guidelines.

• Trend errors, identify root causes, and communicate findings for process improvement.

• Interpret medical documentation to validate coding accuracy.

Qualifications for Claims Resolution Coder

• High school diploma or equivalent (Associate degree in Health Information Technology or Medical Billing preferred).

• CPC or CCS certification required at time of hire.

• 2+ years of hands-on experience in medical coding, billing, or reimbursement.

• Strong knowledge of CPT, HCPCS, revenue codes, and medical billing guidelines.

• Familiarity with radiology, lab, and ancillary coding practices.

• Ability to interpret medical records and ensure compliance with documentation standards.

Compensation and Benefits

• Pay range: $22.36 – $37.26 per hour, with additional opportunities for overtime, shift differentials, and bonuses.

• Comprehensive medical, dental, and vision insurance.

• Paid parental leave, family caregiver leave, and emergency backup care.

• Tuition assistance ($5,250/year) and $10,000 student debt repayment program.

• 401(k)/403(b) with employer match.

• Life insurance, disability plans, and pet insurance.

• Certification reimbursement and CEU/professional development opportunities.