Ambulatory Coder Denials, FT, Days, - Remote

Prisma Health; Boyce Lawn (SC); Remote; USD 45,000 - 65,000; Full time

Job summary

A healthcare organization in South Carolina is seeking an individual responsible for validating coding claims and facilitating the appeals process for denied service claims. The ideal candidate should have at least two years of professional coding experience and must possess a Certified Professional Coder (CPC) certification. Responsibilities include communicating with providers, ensuring documentation supports necessary codes, and participating in educational opportunities. This role operates on a day shift at Independence Pointe.

Qualifications

• Two years of professional coding and/or billing experience required.
• Certified Professional Coder-CPC certification is needed.
• Proficient in word processing, spreadsheets, and databases.

Responsibilities

• Validate coding and facilitate the appeal process for denied claims.
• Communicate with providers regarding coding denial issues.
• Ensure documentation supports CPT, Modifiers, HCPCS, and ICD-10 codes.

Skills

Knowledge of governmental and commercial payer guidelines

Proficient computer skills

Data entry skills

Mathematical skills

Education

High School diploma or equivalent

Associate degree (preferred)

Tools

Coding software

Office equipment (fax/copier)

Job description

Job Summary

Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. All team members are expected to be knowledgeable of payer guidelines related to coding and appeal timelines. Communicates with providers regarding coding denial issues. Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.

• Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals.

• Utilizes appropriate coding software and coding resources in order to determine correct codes.

• Communicates billing related issues

• Follows departmental policies for charge corrections.

• Participates in coding educational opportunities (webinars, in house training, etc.).

• Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns.

• Submits appeals for assigned payer and/or division.

• Assists with Compliance Team and Coding Educators to identify areas that require additional training

• Participates in meetings in order to improve overall billing

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred

• Experience - Two (2) years professional coding and/or billing experience

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• Certified Professional Coder-CPC

Knowledge, Skills and Abilities

• Maintains knowledge of governmental and commercial payer guidelines.

• Knowledge of office equipment (fax/copier)

• Proficient computer skills including word processing, spreadsheets, database

• Data entry skills

• Mathematical skills

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7001 Corporate

Department

70019178 Medical Group Coding & Education Services

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