Scheduled Hours

40

Position Summary

Performs advanced coding and appeal activities; investigates payer issues; responsible for timely filing of appeals to insurance companies; handles charge corrections.

Job Description

• Responsible for appealing claims denied by third-party payers. Creates appropriate letters and compiles documentation to substantiate the validity of claims.

• Investigates and problem solves reimbursement issues in collaboration with other coding staff and faculty. Works directly with physicians and other clinical staff as needed to provide documentation feedback and to develop appeals.

• Researches payer policies and processes.

• Review clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment.

• Works with coders and IBC staff with medical terminology and policy interpretation as required.

• Codes evaluation and management services to the appropriate CPT code level. Ensures ICD codes are linked appropriately to services provided.

• Responsible for charge corrections when necessary.

• Works assigned Epic Work queues, CRM tasks, and reviews remittance advice for rejections and accuracy of payment amounts as needed. Identifies invoices that have been rejected per department criteria.

• Perform accounts receivable (AR) functions in the Epic billing system, including updating insurance information, demographics.

• Special projects as assigned.
   

Working Conditions:
Job Location/Working Conditions:

• Normal office environment.

• Work in the office one day per month.

Physical Effort:

• Typically sitting at desk or table.

Equipment:

• Office equipment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education:

A diploma, certification or degree is not required.

Certifications/Professional Licenses:

The list below may include all acceptable certifications, professional licenses and issuers. More than one credential, certification or professional license may be required depending on the role.

Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physican based (CCS-P) - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Apprentice (CPC-A) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Hospital (CPC-H) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Hospital Apprentice (CPC-H-A) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experience:

No specific work experience is required for this position.

Skills:

Not Applicable

Driver's License:

A driver's license is not required for this position.

More About This Job

Required Qualifications:

• Must have one of the following coding credentials: AHIMA (CCA, CCS, or CCS-P); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the AAPC specialty-specific coding credentials (the specialty-specific credential is only valid for that employee’s department).

Preferred Qualifications:

• Previous coding experience or experience equivalent to an associate’s degree in a related field.
• Knowledge of ICD-10 and CPT coding.

Preferred Qualifications

Education:

Associate degree - Medical Coding & Billing

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