Outpatient Coding Analyst (Remote) (Resided within Midwest)

University Hospitals Pain Management; Shaker Heights (OH); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading health organization seeks a coding specialist responsible for reviewing and managing claims edits. The successful candidate will leverage expertise in regulatory coding to ensure timely processing of claims and resolve coding disputes. A certification in coding and strong analytical skills are essential for success in this pivotal role.

Qualifications

• Knowledge of CPT/PCS and ICD10 coding systems is essential.
• Ability to conduct in-depth analyses of coding-related issues.
• Maintaining certification and ongoing education is required.

Responsibilities

• Review claims edits and leverage coding expertise for processing.
• Assign appropriate CPT/PCS and ICD10 codes for pre-certification.
• Conduct analytic reviews of vendor-generated encounters.

Skills

Analytical Skills

Regulatory Expertise

Coding Knowledge

Attention to Detail

Education

Certified Coding Specialist (CCS)

Job description

DescriptionA Brief Overview

Responsible for research, management and resolution of pre-bill edits, and pre-bill errors. Conducts and or facilitates any other activities related to regulatory related coding requirements reviews, denials, surgery reservation CPT/PCS code(s) assignment and patient inquiries requiring coding review.

What You Will Do

• Reviews claims edits, from different source systems, via assigned work queues, leveraging coding and regulatory expertise, enabling cases to be successfully processed in a timely and accurate manner.
• Prepares material through research of coding and/or payer guidelines for claims denials. Reviews coding and recommends updated coding changes and/or provides appeal documents to follow up Team.
• Responsible for reviewing assigned surgery reservation forms and assigning appropriate CPT/PCS and ICD10 codes to initiate pre certification process.
• Reviews requests from the Customer Service department related to HIS coding disputes.
• Performs analytic reviews of encounters generated by vendors or other external sources.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. Maintains credentials. Maintains updated knowledge of regulatory guidelines and regulations affecting the coding field. Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Trending for potential edits and working with the Coding Educator to develop training and ongoing education based on identified needs.

Additional Responsibilities

• Participates in educational and informational activities.
• Participates in student mentorship programs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.