Resolve Coding Related denials through thorough review of Medical Records to support the billing of various types of services such as E/Ms, Diagnostic Tests, Laboratory, Pathology, Office Procedures, Surgeries, Anesthesia, etc.
- Conduct Audits on Down Coded E/M services
- Conduct Audits and submit supporting documentation in response to Medicare RAC Audits
- Conduct Quality Assurance Reviews on Corrected Claims and Coding Denial Appeals
- Creates/Maintains trackers as necessary for Audits and/or Projects to track and report on outcomes
- Assists in educating the billing staff with accurate and appropriate assignment of ICD-10, CPT/HCPCS, and modifiers for the purposes of billing to ensure maximum reimbursement while also ensuring compliance with regulatory and payer guidelines
- Assist in research and other analytical projects such as evaluating billing and coding practices within departments to ensure compliance and/or identify enhanced revenue opportunities
- Assist in researching CMS, Medicaid, and Payor Guidelines to ensure adherence to correct Coding and Billing Principles surrounding Payor Policies
- Analysis of Coding related denials to identify root cause and areas of opportunity for provider education/training
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* At least 3 years experience as a Medical Coder in an enterprise environment
* CPC Certified
* Hands on experience supporting EPIC PB
* Must maintain their annual credits mandated by the AAPC
* Previously trained in ICD-10, HCPC, and CPT-4 coding
* Advanced proficiency with research and problem-solving skills as it relates to Coding required
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.