Claims and Denial Coding Analyst

sluhn; Allentown (Lehigh County); On-site; USD 60,000 - 85,000; Full time

Job summary

St. Luke's University Health Network in Allentown, PA is seeking an experienced Medical Coder to maintain current coding guidelines, resolve edits and denials, and provide guidance to providers and staff. This role requires knowledge of ICD-10-CM, CPT and HCPCS, with 2+ years in E/M or surgical coding.

The position emphasizes accuracy, collaboration with payors, and ongoing training participation to stay current with industry changes.

Qualifications

• CPC or CCA certification required.
• At least 2 years of active E&M and/or Surgical Coding experience.
• Knowledge of ICD-10-CM, CPT and HCPCS coding.
• Experience dealing with third party insurers related to claim processing and denials.

Responsibilities

• Maintain current knowledge of coding, compliance, and documentation guidelines
• Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
• Resolve coding denials through claim correction or appeal. The appeals process may include collaboration with stakeholders
• Provide coding guidance to providers and charge entry staff for single or low volume errors
• Attend coding conferences, workshops, and in-house sessions to receive updated coding information
• Assist with training new staff in all aspects of the Analyst role

Skills

E/M Coding

Surgical Coding

ICD-10-CM

CPT Coding

HCPCS

Education

CPC or CCA certification

Tools

Epic Resolute

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

HOURS

Full Time, Days, 40 hours/week

No nights, holidays, or weekends

JOB DUTIES AND RESPONSIBILITIES

• Maintain current knowledge of coding, compliance, and documentation guidelines
• Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
• Resolve coding denials through claim correction or appeal. Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator. Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance
• Provide coding guidance to providers and charge entry staff for single or low volume errors. Report high volume coding denial trends to the coordinator
• Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations
• Review TCM Charge Review encounters to verify the documentation supports all required TCM components. Relevel TCM service when not supported by the documentation or TCM has been rendered during another TCM 30-day period
• Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations
• Assists with training new staff in all aspects of the Analyst role.

PHYSICAL AND S E NSORY REQUIRE M ENTS

Sitting for up to 8 hours per day, 3 hours at a time. Standing and walking as necessary. Fingering and handling frequently, twisting and turning of hands occasionally. Pushing and pulling. Occasionally stoops, bends, squats, kneels and reach above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general and near vision.

EDUCAT I ON

CPC or CCA certification required.

TRA I NING AND EX P E RIENCE

At least 2 years of active E&M and/or Surgical Coding experience required. Must possess a comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding. Knowledge and experience in dealing with third party insurance companies relative to claim processing and coding denials follow up. Epic Resolute experience helpful

St. Luke's University Health Network is an Equal Opportunity Employer.