Senior Coding Denials Analyst, Outpatient

Sanford Health; United States; Remote; Full time

Job summary

A leading healthcare organization is seeking a coding compliance specialist to optimize reimbursement processes. This role involves analyzing claim edits, providing training, and collaborating with various departments to enhance coding accuracy. Candidates should possess extensive coding knowledge and relevant certifications.

Qualifications

• Extensive knowledge of diagnostic and procedural terminology.
• Two years' experience in hospital outpatient coding.
• Ability to train others effectively.

Responsibilities

• Identify, edit, and analyze error-related trends.
• Develop validation checks for coding.
• Provide feedback on coding software edits and denial issues.

Skills

ICD-10

CPT-4

HCPCS coding

Computer skills

Knowledge of anatomy

Knowledge of physiology

Knowledge of pathophysiology

Education

RHIA

RHIT

CPC

COC

CCS

CCS-P

Job description

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Salary Range:

$24.00 - $38.50

Union Position:

No

Department Details

Summary

Research and analyze inpatient-related claim edits, returns from providers, denials, internal edits, patient complaints, Patient Financial Services questions and concerns, as well as coding compliance software audit messages to optimize reimbursement for Sanford.

Job Description

1. Identify, edit, and analyze error-related trends. Provide information on findings and trends to enterprise coding leaders for coder education and communication.
2. Participate in developing validation checks and other edits to provide real-time alerts during coding, aiding revenue cycle enhancements.
3. Provide feedback on coding software edits, denial issues, reimbursement trends, and billing/coding errors to providers, coding staff, and organizational departments such as Patient Financial Services, Compliance, and clinical teams.

Qualifications

Must have extensive knowledge of diagnostic and procedural terminology, ICD-10, CPT-4, HCPCS coding schemes, usually acquired through certifications such as RHIA, RHIT, CPC, COC, CCS, or CCS-P. Requires two years' experience in hospital outpatient coding. Must have a working knowledge of anatomy, physiology, and pathophysiology, along with current coding schemes, prospective payment systems, and clinical practices. Computer skills and knowledge of information systems are necessary. Ability to train others effectively and knowledge of relevant laws and regulations are required. Certification must be maintained through continuing education; if not certified at hire, certification must be obtained within one year.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [e-mail].