Ambulatory Coder Denials, FT, Days, - Remote

Prisma Health; Greenville (SC); Remote; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking healthcare organization dedicated to transforming community health. In this essential role, you will validate coding and manage the appeals process for denied claims, ensuring compliance with payer guidelines. Your expertise in professional coding and communication will help resolve issues efficiently. This position offers the opportunity to enhance your skills through educational training and contribute to improving billing processes. If you're passionate about making a difference in healthcare, this role is for you.

Qualifications

• 2 years of professional coding or coding/billing experience required.
• Certified Professional Coder (CPC) certification is mandatory.

Responsibilities

• Validate coding and facilitate appeals for denied claims.
• Communicate with providers regarding coding denial issues.
• Utilize coding software to determine correct codes.

Skills

Professional coding

Billing experience

Basic computer skills

Mathematical skills

Knowledge of office equipment

Proficient in word processing

Proficient in spreadsheets

Proficient in database

Data entry skills

Education

High School diploma or equivalent

Associate degree

Job description

Inspire health. Serve with compassion. Be the difference.

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.

Accountabilities

• Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals. 40%

• Utilizes appropriate coding software and coding resources in order to determine correct codes. 15%

• Follows departmental policies for charge corrections. 5%

• Participates in coding educational opportunities (webinars, in house training, etc.). 5%

• Provides timely feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns. 5%

• Submits appeals for assigned payer and/or division. 5%

• Maintains knowledge of governmental and commercial payer guidelines. 5%

• Assists with Compliance Team and Coding Educators to identify areas that need additional training, if applicable. 5%

• Communicates billing related issues to assigned supervisor/manager. 10%

• Participates in A/R Meetings in order to improve overall billing when applicable. 5%

Supervisory/Management Responsibilities

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

Minimum Requirements

• High School diploma or equivalent or post-high school diploma / highest degree earned

• Associate degree - Preferred

• 2 years - Professional coding or combination of coding/billing experience

Required Certifications/Registrations/Licenses

Certified Professional Coder-CPC

Required Knowledge & Skills

• Basic computer skills

• Knowledge of office equipment (fax/copier)

• Proficient computer skills including word processing, spreadsheets, database and data entry

• Mathematical skills

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 simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.