Responsible for the validation of coding for physician-billed services, including inpatient and outpatient procedures, ensuring claims are submitted to insurance payers in the most compliant, efficient, and expeditious manner possible.
Performs escalated review of medical documentation at an advanced level from clinicians, qualified health professionals, and hospitals to validate medical necessity of services rendered. Appeals advanced levels of medical appeals with insurance payers to recover denied payment while validating the integrity of coded charges and billed claims.
Reviews clinician documentation to support assigned codes in the health information record so that significant diagnoses and procedures are captured for reimbursement and data purposes. Conducts independent research to stay current on coding guidelines, regulatory policies, and trends.
Provides education to providers on denial practices and payer medical policies. Recommends policy and procedure updates as needed to align with government regulations. Processes medical necessity claim denials when applicable and appropriately appeals denied claims using professional coding oversight.
This position has a direct financial impact and supports internal data management and external reporting.
Advanced training beyond high school in medical coding or a related field, or equivalent knowledge and experience.
Coding certification from AAPC or AHIMA required.
Typically requires 3 years of experience in professional coding, including experience in hospital or professional revenue cycle processes and health information workflows.
Advanced knowledge of ICD, CPT, and HCPCS coding guidelines.
Advanced knowledge of medical terminology, anatomy, and physiology.
Intermediate computer skills, including Microsoft Office, email, and exposure to electronic coding systems or applications.
Advanced communication, interpersonal, organization, prioritization, reading comprehension, and analytical skills.
Ability to work independently, exercise sound judgment, meet deadlines, and work collaboratively in a fast-paced environment.
Full-time status with benefits eligibility.
Paid time off programs.
Medical, dental, vision, life, and short- and long-term disability coverage.
Flexible spending accounts for eligible health care and dependent care expenses.
Family benefits such as adoption assistance and paid parental leave.
Defined contribution retirement plans with employer match and financial wellness programs.
Educational assistance program.
Opportunity for annual increases based on performance.
Premium pay and incentive pay may apply to select positions.
Location
Winston-Salem, North Carolina, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago