Ambulatory Coder Denials II, FT, Days, - Remote

Prisma Health
United States, South Carolina, Greenville
300 East McBee Avenue (Show on map)
Nov 09, 2024
Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. All team members are expected to be knowledgeable of payer guidelines related to coding and appeal timelines. Communicates with providers regarding coding denial issues. Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc. Accountabilities Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals. 40% Utilizes appropriate coding software and coding resources in order to determine correct codes. 15% Follows departmental policies for charge corrections. 5% Participates in coding educational opportunities (webinars, in house training, etc.). 5% Provides timely feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns. 5% Submits appeals for assigned payer and/or division. 5% Maintains knowledge of governmental and commercial payer guidelines. 5% Assists with Compliance Team and Coding Educators to identify areas that need additional training, if applicable. 5% Communicates billing related issues to assigned supervisor/manager. 10% Participates in A/R Meetings in order to improve overall billing when applicable. 5% Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements High School diploma or equivalent or post-high school diploma / highest degree earned Associate degree - Preferred 2 years - Professional coding or combination of coding/billing experience Required Certifications/Registrations/Licenses Certified Professional Coder-CPC Required Knowledge & Skills Basic computer skills Knowledge of office equipment (fax/copier) Proficient computer skills including word processing, spreadsheets, database and data entry Mathematical skills Work Shift Day (United States of America) Location Independence Pointe Facility 7001 Corporate Department 70019178 Medical Group Coding & Education Services Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.