Ventra Health is seeking an experienced Medical Coding Escalation Specialist to join our dynamic team and lead the resolution of complex coding challenges. As a Medical Coding Escalation Specialist, you will play a critical role in ensuring coding accuracy, compliance, and quality across multiple healthcare services. You will review escalated cases, provide expert guidance to coding staff, and collaborate with auditors, providers, and compliance teams to maintain regulatory standards. This position offers an excellent opportunity for professionals to advance their career in medical coding while making a meaningful impact on revenue cycle management and patient care.
Why Work as a Medical Coding Escalation Specialist at Ventra Health
At Ventra Health, the Medical Coding Escalation Specialist is a key contributor to our mission of delivering transparent, data-driven revenue cycle solutions. You’ll join a supportive environment that emphasizes professional growth, recognition, and rewards. Through our performance-based incentive program, your expertise and achievements are acknowledged and celebrated.
Key Responsibilities of a Medical Coding Escalation Specialist
As a Medical Coding Escalation Specialist, you will:
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Review and resolve escalated coding issues from coders, auditors, billing teams, and providers.
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Analyze medical records and documentation to ensure accurate code assignment in compliance with CMS, AHA, and payer-specific guidelines.
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Serve as a subject matter expert in coding regulations and industry standards.
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Identify trends, discrepancies, and compliance risks, recommending corrective actions to improve coding accuracy.
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Mentor and educate coding staff on complex cases, documentation requirements, and coding updates.
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Participate in coding audits and help implement process improvements for documentation and workflow efficiency.
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Maintain up-to-date knowledge of regulatory changes, payer policies, and coding standards.
Skills and Expertise Required
A successful Medical Coding Escalation Specialist demonstrates:
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Expert knowledge of ICD-10-CM, CPT, and HCPCS coding systems.
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E/M leveling experience and proficiency in handling complex coding cases.
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Strong understanding of CMS regulations, payer-specific guidelines, and compliance standards.
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Excellent analytical, problem-solving, and decision-making abilities.
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Effective communication and interpersonal skills to collaborate with diverse teams.
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Experience with EHRs and coding software, along with proficiency in Outlook, Word, Excel (pivot tables), and database systems.
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Ability to manage multiple priorities in a fast-paced environment.
Education and Experience
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Minimum 3–5 years of medical coding experience with emphasis on complex case review or quality assurance.
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Certification required: AAPC or AHIMA credential (e.g., CPC, CRC, or RHIT).
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Strong foundational knowledge of anatomy, physiology, and clinical documentation requirements.
Compensation and Benefits
Ventra Health offers competitive base compensation determined by experience, skill set, location, and qualifications. This position is also eligible for a discretionary incentive bonus. Our rewards program encourages performance excellence and provides opportunities for recognition and professional growth.
About Ventra Health
Ventra Health is a leading business solutions provider supporting facility-based physicians in anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with hospitals, private practices, and ambulatory surgery centers to provide transparent, data-driven solutions that improve reimbursement processes and allow clinicians to focus on patient care.