PN Cert Prof Coding Denial Specialist

Cook Children's Health Care System; Town of Texas (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A recognized healthcare provider is seeking a Certified Professional Coding Denial Specialist to work remotely. This role involves analyzing complex coding denials and resolving issues while effectively communicating with payers. Required qualifications include a high school degree and significant coding experience, along with relevant certifications. Competitive benefits and a supportive work environment are offered.

Qualifications

• At least 4-5 years of relevant experience in a medical practice.
• At least 3 years of dedicated coding experience.
• Working knowledge of ICD and CPT code sets.

Responsibilities

• Review and determine root cause of complex coding denials.
• Resolve coding-related claims edits and payer denials.
• Communicate effectively with payers to defend code assignment.

Skills

Interpersonal skills

Education

High school degree or equivalent

Tools

Microsoft Excel

Job description

Overview

Location: Remote - TX

Department: CBO/PT Financial Services

Shift: First Shift (United States of America)

Standard Weekly Hours: 40

Summary

The Certified Professional Coding Denial Specialist is responsible for reviewing and determining the root cause of complex coding denials for all providers employed by Cook Children's Physicians Network. This includes resolving complex coding issues, coding-related claims edits, and payer denials directly attributable to code assignment, while actively communicating effectively with payers to defend code assignment and successfully appealing coding-related denials using CMS, AMA, AAPC, and other governing entity guidelines to overturn them. The specialist will analyze and perform appropriate actions for timely completion of special projects, utilizing their deep understanding of coding and classification software and the electronic health record (EHR) system.

Education & Experience

• High school degree or equivalent with at least 4-5 years of relevant experience in a medical practice or professional healthcare setting
• This must include at least 3 years of dedicated coding experience
• Working knowledge of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) code sets
• Comprehensive understanding of diversified payer clinical and reimbursement policies, advanced medical terminology, and proficiency in Microsoft Excel

Knowledge, Skills & Abilities

• Exhibits professional interpersonal and communication skills

Certification/Licensure

• Current coding certification through the American Academy of Procedural Coders (AAPC) or American Health Information Management Association (AHIMA) required

About Cook Children\'s

Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children\'s is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.

At Cook Children\'s, we\'re more than a health care system—we\'re your friends, neighbors and even family members. And we\'re parents too, so we can see the world through your eyes. We see what you\'re going through—and how we can help you and your child get the best care and support possible.

Cook Children\'s is an equal opportunity employer. Cook Children\'s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.