Grade 104
Position Summary
The Coding Specialist III is responsible for the review and resolution of coding-related pre-billing edits and rejections to ensure prompt and accurate reimbursement. This role initiates medical record review, recommends appropriate action, and works closely with the Directors of Revenue and Practice Operations to adjudicate and resolve claims.
Responsibilities
- Review and resolve assigned tasks and encounters associated with coding discrepancies, pre-billing system edits, and claims with outstanding balances.
- Reduce accounts receivable by reviewing claims rejected for coding and determining what additional steps are needed for resolution.
- Provide guidance and suggestions to clinical departments regarding pre-billing coding edits.
- Maintain patient confidentiality and comply with HIPAA and hospital compliance guidelines.
- Review and follow up on denials related to coding and charge entry processes.
- Research medical records and communicate with insurance companies and clinicians to resolve coding-related claim denials.
- Manage appeals with insurance companies for surgical claim reimbursement when appropriate.
- Assess clinical documentation supporting services.
- Oversee insurance coding requests.
- Assist with claim issues, including preparing coding appeals.
- Serve as a liaison between clinicians, billing consultants, patient financial counselors, and insurance carriers regarding coding issues.
- Review and analyze coding trends to reduce unnecessary coding rejections.
- Create new edits related to payor and CMS guidelines for release to the clearinghouse.
- Train new coders and billers.
- Support other functions as assigned.
Requirements & Qualifications
Minimum Qualifications
- Bachelor's degree or equivalent education and experience.
- Three years of related experience.
Preferred Qualifications
- Certified Professional Coder (CPC).
- Intermediate MS Office skills.
Other Requirements
- Transplant coding knowledge.
- Knowledge of CPT and ICD-10 coding.
- Strong written and verbal communication skills.
- Working knowledge of contracts, insurance billing requirements, payers, Medicare, and Medicaid.
- Ability to follow through and handle multiple tasks simultaneously.
- Proven ability to exceed standard productivity levels.
- Proven attendance and punctuality record.
Location
New York, New York, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$72,000 - $85,000
Remote work allowed
No
Posted
1 month ago
Browse More Jobs