[Hiring] Certified Coder Payment Recovery Specialist @CommonSpirit Health

Role Description

As our Payment Recovery Specialist, you will accurately review records for coding errors and correct diagnostic and procedural codes in the billing system for the purpose of reimbursement utilizing ICD-10-CM, CPT, HCPCS, and proper modifiers.

• Analyze and interpret complex data daily.
• Combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations.
• Identify and communicate payer and/or system trends to Management.
• Maintain thorough knowledge of payer contracts, regulations, and guidelines, as well as state and federal laws relating to billing and collection procedures.
• Communicate with courtesy and tact to fellow employees and external customers to promote better quality and more efficient customer service.
• Utilize Centricity and/or related modules to obtain, analyze, and interpret coding denials and other reimbursement data.
• Manage and correct denied claims for coding issues, such as unbundling, medical necessity, and coding errors.
• Ensure all coding error corrections accurately reflect the services provided, dates of service(s), identity of person providing services, and diagnosis is accurate and carried to the highest level of specificity.
• Analyze, investigate, and follow up on denied claims.
• Manage all assigned denial work files and address denials independently in a timely manner.
• Review and adhere to all Dignity Health coding policies and procedures.

Qualifications

• High School Graduate
• Three (3) years of experience
• Three (3) years prior experience in medical coding and/or billing for physician office services
• Proficiency assigning ICD-10-CM, CPT, HCPCS, and modifiers
• Certified Professional Coder (CPC)
• Certified Professional Coder Hospital Apprentice (CPC-HA)
• Certified Professional Coder Apprentice (CPCA)
• Certified Coding Associate (CCA)
• Cardiology Coding (CCC)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist - Physician Based (CCS-P)
• Registered Health Information Administrator (RHIA)
• Ability to read and comprehend an EOB
• Proficient in guidelines, CCI, LMRP, coding, and use of modifiers
• Ability to research CPT/ICD10 codes to bill appropriately
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules)
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials, and appeals recovery
• Proficient understanding of medical coding systems affecting the adjudication of claims payment

Requirements

• Associates degree (preferred)
• Five (5) years of experience (preferred)
• Five (5) years work experience in medical billing and coding for physician office services (preferred)