Ambulatory Coder Denials, FT, Days, - Remote

Prisma Health; Columbia (SC); Remote; USD 50,000 - 65,000; Full time

Job summary

A leading healthcare provider is seeking a detail-oriented Coding Specialist to validate coding and manage appeals for denied claims. The role requires strong communication skills and knowledge of coding guidelines. Join us to make a difference in healthcare!

Qualifications

• Two years of professional coding and/or billing experience required.
• Certified Professional Coder (CPC) certification required.

Responsibilities

• Validate coding and facilitate appeals for denied claims.
• Communicate with providers regarding coding denial issues.
• Participate in coding educational opportunities.

Skills

Coding

Communication

Data Entry

Mathematical Aptitude

Education

High School Diploma

Associate Degree

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for validating coding and facilitating the appeals process for all assigned denied professional service claims. Team members should 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

• Adhere to Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
• Work accurately and timely to resolve coding claim denials, meeting performance and productivity goals.
• Use appropriate coding software and resources to determine correct codes.
• Communicate billing-related issues effectively.
• Follow departmental policies for charge corrections.
• Participate in coding educational opportunities such as webinars and in-house training.
• Provide feedback to providers or office liaisons to clarify and resolve coding concerns.
• Submit appeals for assigned payers and divisions.
• Assist with identifying training needs in collaboration with the Compliance Team and Coding Educators.
• Participate in meetings to improve overall billing processes.
• Perform other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management position reporting to a supervisor, manager, director, or executive.

Minimum Requirements

• High School diploma or equivalent; associate degree preferred.
• Two (2) years of professional coding and/or billing experience.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• Certified Professional Coder (CPC)

Knowledge, Skills, and Abilities

• Maintain knowledge of governmental and commercial payer guidelines.
• Proficient with office equipment (fax/copier).
• Strong computer skills including word processing, spreadsheets, and databases.
• Effective data entry skills.
• Mathematical aptitude.

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7001 Corporate

Department

70019178 Medical Group Coding & Education Services

Share your talent with us! Our vision is to transform healthcare for the communities we serve. We seek talented individuals in every role to help achieve this mission at Prisma Health.