Physician Coding & Denials Resolution Specialist II

University Hospitals Pain Management; Shaker Heights (OH); Remote; USD 60.000 - 75.000; Vollzeit

Zusammenfassung

University Hospitals Pain Management seeks a Physician Coding Specialist II to monitor and analyze unresolved third party accounts for multi-specialty group practices, initiating contact and negotiating resolutions to ensure timely payments. Responsibilities include coding edits, denials review, and potential ICD-10 coding from documentation.

Role requires knowledge of payer guidelines, effective communication with payors and internal teams, and adherence to PHI security and departmental

Qualifikationen

• Experience with physician coding and medical billing processes.
• Ability to review and correct coding edits and denials.
• Capable of handling PHI with confidentiality and professionalism.

Aufgaben

• Analyzes unresolved third party insurance accounts daily and follows up as needed.
• Communicates with payors and internal departments to obtain information impacting claim resolution.
• Researches customer service inquiries promptly and professionally.
• Reviews coding edits and denials; may code ICD-10 from documentation.
• May abstract CPT/HCPCS codes and perform computer-assisted coding.
• Adheres to coding rules, payer guidelines, and department productivity and quality standards.
• Maintains patient/physician confidentiality and professional interaction with patients and physicians.
• Identifies trends in insurance issues and reports findings to leadership.

Kenntnisse

Coding rules knowledge

ICD-10 coding

CPT/HCPCS coding

Phone and payer communications

PHI confidentiality

Tools

Computer-assisted coding

Jobbeschreibung

University Hospitals Pain Management seeks a Physician Coding Specialist II to monitor and analyze unresolved third party accounts for multi-specialty group practices, initiating contact and negotiating resolutions to ensure timely payments. Responsibilities include coding edits, denials review, and potential ICD-10 coding from documentation.

Role requires knowledge of payer guidelines, effective communication with payors and internal teams, and adherence to PHI security and departmental