Certified Coder Payment Recovery Specialist

Dignity Health; Phoenix (AZ); On-site; USD 69,781,000 - 103,699,000; Full time

Job summary

Dignity Health Medical Group in Phoenix, AZ is seeking a Payment Recovery Specialist to review records for coding errors and correct diagnostic and procedural codes in the billing system to optimize reimbursement. You will analyze denial trends and communicate payer and system insights to management.

The role requires a strong knowledge of ICD-10-CM, CPT, HCPCS, and modifiers, with a focus on accurate, compliant billing and timely issue resolution.

Qualifications

• High School graduate required.
• Three (3) years prior experience in medical coding and/or billing for physician office services.
• Proficiency assigning ICD-10-CM, CPT, HCPCS and modifiers.
• Certified Professional Coder (CPC).
• CPC-HA certified.
• CPCA certified.
• CCA certified.
• CCC certified.
• CCS certified.
• CCS-P certified.
• RHIA certification.
• Ability to read and comprehend an EOB.
• Proficient in guidelines, CCI, LMRP, coding, use of modifiers.
• Ability to research CPT/ICD-10 codes to bill appropriately.
• Proficient in all aspects of reimbursement (benefit investigations, payer reimbursement policies, regulatory and administrative rules).
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery.
• Proficient understanding of medical coding systems affecting the adjudication of claims payment.

Responsibilities

• Utilizes Centricity and related modules to obtain, analyze and interpret coding denials and other reimbursement data to support compliance and billing concepts and procedures.
• Manages and corrects denied claims for coding issues to facilitate payment and resolution.
• Ensures all coding corrections reflect services provided, dates of service, provider identity, and accurate diagnosis.
• Analyzes, investigates and follows up on denied claims; manages denial work files and addresses denials timely.
• Reviews and adheres to Dignity Health coding policies and procedures.

Skills

ICD-10-CM

CPT

HCPCS

Modifiers

CPC

CPC-HA

CPCA

CCA

CCC

CCS

CCS-P

RHIA

EOB reading

Denials analysis

Reimbursement rules

Coding compliance

Education

Associates degree

Job description

Job Summary And Responsibilities

As our Payment Recovery Specialist, you will accurately review records for coding errors and correct diagnostic and procedural codes in billing system for the purpose of reimbursement utilizing ICD-10-CM, CPT, HCPCS, and proper modifiers.

Job Summary And Responsibilities

As our Payment Recovery Specialist, you will accurately review records for coding errors and correct diagnostic and procedural codes in billing system for the purpose of reimbursement utilizing ICD-10-CM, CPT, HCPCS, and proper modifiers.

Every day, you will analyze and interpret complex data.

To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations.

You must be able to identify and communicate payer and/or system trends to Management. Maintains thorough knowledge of payer contracts, regulations and guidelines, as well as state and federal laws relating to billing and collection procedures to ensure accurate and compliant billing processes. Communicate with courtesy and tact to fellow employees and external customers to promote better quality and more efficient customer service.

• Utilizes Centricity and/or related modules to obtain, analyze and interpret coding denials and other reimbursement data to support compliance and billing concepts and procedures.
• Manages and corrects denied claims for coding issues, i.e., unbundling, medical necessity, coding errors, etc as determined by management to facilitate payment and resolution.
• Ensures all coding error corrects accurately reflect the services provided, dates of service(s), identity of person providing services, and diagnosis is accurate and carried to highest level of specificity, etc.
• Analyzes, investigates and follows-up on denied claims. Manages all assigned denial work files, understands and addresses denials independently in a timely manner.
• Reviews and adheres to all Dignity Health coding policies and procedures.

Job Requirements

Required

• High School Graduate
• Three (3) years prior experience in medical coding and/or billing for physician office services
• Proficiency assigning ICD-10-CM , CPT, HCPCS ,and modifiers
• Certified Professional Coder, (CPC)
• Certified Professional Coder Hospital Apprentice (CPC-HA)
• Certified Professional Coder Apprentice (CPCA)
• Certified Coding Associate (CCA)
• Cardiology Coding (CCC)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist - Physician Based (CCS-P)
• Registered Health Information Administrator (RHIA)
• Proficiency assigning ICD-10-CM , CPT, HCPCS, and modifiers
• Ability to read and comprehend an EOB
• Proficient in guidelines, CCI, LMRP, coding, use of modifiers
• Ability to research CPT/ICD10 codes to bill appropriately
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules)
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery
• Proficient understanding of medical coding systems effecting the adjudication of claims payment

Preferred

• Associates degree
• Five (5) years of experience
• Five (5) years work experience in medical billing and coding for physician office services

Where You'll Work

Hello Humankindness

Where Your Passion Meets Purpose: Join Dignity Health Medical Group

Are you a healthcare professional who believes that every patient deserves not just treatment, but unwavering compassion? Do you envision a world where healthcare isn't just a service, but a fundamental right, delivered with integrity and innovation? If so, then Dignity Health Medical Group (DHMG) is where your career finds its true calling.

At Dignity Health Medical Group, you're not just filling a role; you're becoming an architect of healthier communities. We are the employed physician group of Dignity Health Arizona, and our success isn't just measured in numbers, but in the lives we touch and the advancements we champion.

Here's what sets us apart and why you belong with us:

• Impact that Resonates: You'll be part of a team delivering comprehensive clinical services, making a tangible difference in the lives of countless individuals. From cutting-edge diagnostics to life-changing treatments, your expertise will directly contribute to improved health outcomes.
• A Culture of Growth and Innovation: We don't just practice medicine; we advance it.
• Shaping the Future of Healthcare: DHMG is deeply invested in preparing tomorrow's healthcare providers. We seamlessly blend clinical services with translational and bench research, creating a dynamic environment that augments medical education for residents and students.
• Values-Driven Mission: We are united by a powerful set of principles. If you are deeply committed to social justice, health equity, and are prepared to deliver care in new, innovative ways, your values align perfectly with ours. We believe that everyone, regardless of background, deserves access to high-quality healthcare, and we actively work to make that a reality.
• A Supportive and Collaborative Environment: We believe in building a strong, inclusive team where everyone feels valued and respected.

Are you ready to transcend the ordinary and join a healthcare family where your skills are celebrated, your voice is heard, and your passion for healing finds its ultimate expression?

If you're eager to contribute to an organization that is making a profound difference, where innovation meets compassion, and where your commitment to social justice and health equity will be not just welcomed, but celebrated – then Dignity Health Medical Group is waiting for you.

Pay Range

$24.33 - $36.19 /hour