Ambulatory Coder Denials II, FT, Days, - Remote

Prisma Health; Columbia (SC); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare provider in South Carolina seeks a Coding Specialist to validate coding and facilitate the appeals process for denied claims. The role requires knowledge of payer guidelines and effective communication with providers. Ideal candidates will have coding experience and relevant certifications.

Qualifications

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

Responsibilities

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

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

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.

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

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.