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Advanced Coding Accuracy & Optimization:
- Perform complex coding for CPT, HCPCS, and ICD-10.
- Apply and validate advanced modifier usage.
- Conduct deep-dive research on payer policies.
MDM-Based Coding (E/M Optimization):
- Perform manual chart reviews using Medical Decision Making (MDM) guidelines.
- Validate appropriate E/M level selection.
- Identify opportunities for appropriate upcoding where documentation supports higher acuity.
Denial Prevention & Resolution Support:
- Lead analysis of coding-related denials and rejections.
- Identify root causes and drive upstream fixes to prevent recurrence.
- Provide expert guidance on complex denial scenarios and appeals strategy.
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