Coding Specialist

PathGroup; Nashville (TN); On-site; USD 60,000 - 90,000; Full time

Job summary

PathGroup in Nashville, TN seeks a Coding Specialist with knowledge of RCM denial management to resolve coding-related third-party payor denials. The role aims to increase service revenue, reduce aged AR, and trend denials for root causes through documentation improvement and denial prevention.

You will perform front-end review of documentation, analyze denial trends, and conduct retrospective coding reviews to ensure services billed are supported by records.

Qualifications

• Knowledge of RCM denial management and coding standards.
• Experience reviewing medical records to ensure documentation supports billed services.
• Strong ability to follow regulatory guidelines and maintain privacy and security policies.

Responsibilities

• Performs front-end review of client documentation to ensure the claim is billed accurately and requisitions are complete.
• Analyze invalid denial trends, payer-specific carrier submission requirements and system optimization.
• Performs retrospective coding and documentation review of denied charges; reviews records for completeness and accuracy.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Ensures denial reviews are conducted on time and complies with mandatory trainings.
• Meets productivity standards and communicates issues or trends to management.

Job description

Job Summary

The Coding Specialist has knowledge of RCM denial management to resolve coding-related third party payor denials. Coding Specialists increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include documentation improvement and coding denials prevention.

Job Summary

The Coding Specialist has knowledge of RCM denial management to resolve coding-related third party payor denials. Coding Specialists increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include documentation improvement and coding denials prevention.

Job Responsibilities

ESSENTIAL FUNCTIONS

• Performs front-end review of client documentation to ensure the client has provided documentation that supports the requested services. Review requisitions to ensure the claim is billed accurately.
• Analyze invalid denial trends, payer-specific carrier submission requirements & system optimization.
• Performs retrospective coding and documentation review of denied charges. Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing and works with referring providers to obtain additional information as needed.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Ensures denial reviews are conducted on time.
• Participates in annual and ongoing mandatory employee training. Fulfills Continuing Education Units necessary to maintain certification status.
• Meets productivity standards, identify any issues or trends and bring them to the attention of management.
• Demonstrates excellent interpersonal, verbal and communication skills.
• Follows coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
• Demonstrates the ability to function independently, and use critical thinking and analytical skills.
• Performs all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including the Privacy and Security policies.

Non-essential Functions

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.