The Coding Specialist has knowledge of RCM denial management to resolve coding-related third party payor denials. Coding Specialists increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include documentation improvement and coding denials prevention.

JOB RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

• Performs front-end review of client documentation to ensure the client has provided documentation that supports the requested services. Review requisitions to ensure the claim is billed accurately.
• Analyze invalid denial trends, payer-specific carrier submission requirements & system optimization.
• Performs retrospective coding and documentation review of denied charges. Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing and works with referring providers to obtain additional information as needed.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Ensures denial reviews are conducted on time.
• Participates in annual and ongoing mandatory employee training. Fulfills Continuing Education Units necessary to maintain certification status.
• Meets productivity standards, identify any issues or trends and bring them to the attention of management.
• Demonstrates excellent interpersonal, verbal and communication skills.
• Follows coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
• Demonstrates the ability to function independently, and use critical thinking and analytical skills.
• Performs all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including the Privacy and Security policies.

NON-ESSENTIAL FUNCTIONS:

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

EDUCATION & LICENSURE:

• High school diploma or GED is required.
• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is preferred, not required.
• Certified from AHIMA or from AAPC preferred, not required.

REQUIREMENTS:

• Knowledge of CPT and ICD 10 coding experience is preferred
• Knowledge of governmental payor policies and medical billing experience is preferred.
• Prior experience working with an eMR systems preferred.
• Knowledge of third-party reimbursement and payor policies
• Microsoft Excel and other reporting software to sort, filter, summarize and identify various account receivable trends.