Under direct supervision of the Revenue Cycle Manager, this role reviews and resolves coding issues related to billing, researches coding issues, and participates in process improvements related to coding and AR management. The position may also provide education to providers and staff on correct documentation, coding, and billing of medical claims.
- Work with accuracy and ensure changes are within the scope of policy.
- Check that claims are passing internal edits in a timely fashion.
- Ensure denied claims are corrected or appealed in a timely manner.
- Provide appropriate feedback to management.
- Determine that appropriate information is submitted to insurance companies.
- Ensure actions taken on denied claims are paid on the first follow-up call or appeal.
- Maintain up-to-date knowledge of billing and reimbursement.
- Identify and communicate AR trends and denial issues impacting AR or daily production.
- Meet productivity and accuracy standards.
- Request appropriate adjustments based on contract, modifiers, or appeal denials.
- Understand procedures billed in operative notes and bundling issues to maximize the value of submitted appeals.
- Use coding resources such as CPT, ICD-10, AAOS books, Decision Health, and Select Coder to understand denied procedures.
- Correct accounts that are billed incorrectly in the practice management system.
- Help Revenue Cycle Specialists understand and complete correction requests.
- Ensure compliance with company plans, policies, and procedures.
- Perform other duties as assigned.
Requirements & Qualifications
- High school diploma or GED required.
- CPC, CPC-A, RHIT, or CCS certification required.
- 2 to 4 years of experience.
- Knowledge of ICD-10, CPT, HCPCS, and modifiers preferred.
- Surgical coding experience preferred.
- Knowledge of Medicare Part B and commercial insurance products and plans.
- Familiarity with CMS 1500 completion preferred.
- Advanced understanding of medical terminology and anatomy.
- Familiarity with NCCI guidelines.
- Athena experience preferred.
- Excellent written and verbal communication skills.
- Detail-oriented and self-starter.
- Strong computer skills, including Microsoft Office Suite.
- Ability to work in a fast-paced environment.
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago
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