Revenue Integrity Coder

FirstHealth of the Carolinas, Inc.; Brantford; Remote; CAD 50,000 - 90,000; Full time

Job summary

An innovative healthcare organization is seeking a dedicated coding specialist for a remote position. This role involves processing denial follow-ups and appeals for multi-specialty providers, ensuring compliance with regulations and optimizing revenue capture. The ideal candidate will have experience in physician practice and coding certifications, demonstrating strong analytical and problem-solving skills. Join a forward-thinking team that values accuracy and efficiency in healthcare billing and coding, and help make a difference in patient care through effective claims management.

Qualifications

• 3+ years experience in physician group practice using EMR and billing systems.
• Certification in Coding (CPC or CCS-P) is preferred.

Responsibilities

• Process denial and appeals claims for medical providers ensuring compliance.
• Analyze coding adjustments and execute denial resolution strategies.

Skills

Communication Skills

Problem-Solving Skills

Analytical Ability

Payer Billing Knowledge

Education

Bachelor Degree in Business

Bachelor Degree in Healthcare Administration

Bachelor Degree in Information Systems

Certification in Coding (CPC or CCS-P)

Tools

EPIC Software

MS-Windows

Job description

Overview

Remote coding position that is responsible for coding denial follow-up work queues and appeals processing for FHPG for multi-specialty providers.

Responsibilities

1. Responsible for denial and appeals claim processing for medical providers and laboratory services ordered by FHPB, ensuring compliance with contractual obligations and State and Federal laws and regulations, and generating appeals for denied or underpaid claims.
2. Analyze all coding adjustments made on EOB to ascertain accuracy and validity. Determine and execute the best approach for denial resolution and processing appeals in accordance with Federal, State, and payer guidelines.
3. Ensure timeliness of appeals, generate appeals based on dispute reason(s), request and obtain medical records as needed for appeal, and document all actions taken during the appeal process and any required follow-up.
4. Assist manager in identifying coding errors that generate denials and help to establish front-end charge review edits to decrease denials.
5. Review claims with 22, 52 & 53 modifiers in the claims requiring attachments work queue, initiate requests for records utilizing EPIC software, and submit required documentation for claims following payer requirements.
6. Work with Assist Dir of Specialty Coding & Revenue Integrity to utilize workflows set in place to minimize late charges, optimize revenue capture, and identify trends within clinic areas that need attention.
7. Assist with Pre-AR coding as needed.

Qualifications

Education/formal training/licensure/certifications/experience:

Prefer Bachelor Degree in Business, Healthcare Administration, or Information Systems; experience may be accepted in lieu of education or formal training. Three years of experience in physician group practice that utilizes EMR and Billing systems to perform daily activities. Greater than three years’ experience in Clinic Practices and Clinic Billing. Certification in Coding either CPC or CCS-P.

Additional Skills:

Knowledge of PCs and MS-Windows. Strong communication and interpersonal skills. Strong problem-solving skills. Analytical ability needed to understand system processes and troubleshoot system issues. Proficient in electronic spreadsheet and database applications. Payer billing and coding knowledge.