[Hiring] Coding Analyst Denials Appeals @Dignity Health Medical Group

Role Description

As our Coding Analyst Denials Appeals, 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.
• Investigate, correct, and resubmit medical claims that have been rejected or denied by an insurance company.
• Work on coding-related denials for multiple specialties across the market.
• Accurately review medical records for coding errors and correct modifiers, ICD-10, CPT, or HCPCS codes in the practice management system.
• Submit corrected claims, reconsiderations, and appeals to the health plan.
• 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 practices.
• Clearly communicate with coworkers, leadership, and outside organizations to meet departmental goals and ensure timely reimbursement.

Qualifications

• High School Graduate
• Three (3) years prior experience in medical coding and/or billing for physician office services
• Proficiency assigning ICD-10-CM, CPT, HCPCS, and modifiers
• Ability to read and comprehend an EOB
• Proficient in guidelines, CCI, LMRP, coding, 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
• Proficiently utilizes Google Workspace
• One of the following Certifications:
  • Certified Professional Coder (CPC)
  • Certified Professional Coder Apprentice (CPCA)
  • Certified Coding Specialist (CCS)
  • Certified Coding Specialist - Physician Based (CCS-P)
  • Certified Cardiovascular and Thoracic Surgery Coder (CCVTC)
  • Certified Health Care Compliance (CHC)
  • Certified Interventional Radiology Cardio Coder (CIRCC)
  • Radiology Certified Coder (RCC)
  • Registered Health Information Administrator (RHIA)
  • Registered Health Information Technician (RHIT)

Requirements

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