[Hiring] Coding Suspends Specialist @Ventra Health

Role Description

We are seeking a detail-oriented and experienced Healthcare Medical Coding Suspends Specialist to join our team. The ideal candidate will have a strong background in medical coding and billing, with expertise in identifying and resolving coding-related suspends. The Medical Coding Suspends Specialist will be responsible for reviewing and resolving coding-related suspends to ensure accurate and timely claim submission and reimbursement.

• Review and analyze coding-related suspends generated by coding software or systems, identifying errors, discrepancies, and missing information.
• Conduct thorough reviews of medical records, encounter forms, and other relevant documentation to validate code assignments and ensure compliance with coding guidelines and regulations.
• Research and interpret coding guidelines, policies, and regulations, including CPT, ICD-10, HCPCS, and payer-specific coding requirements, to accurately assign and sequence diagnosis and procedure codes.
• Collaborate with coding and billing staff, clinicians, and other stakeholders to gather additional information, clarify documentation, and resolve coding-related issues.
• Correct code assignments, modifiers, and other coding elements as needed to address coding-related suspends and ensure accurate claim submission.
• Document coding-related activities, findings, and resolutions in coding software or systems, maintaining accurate and complete records of coding-related suspends and resolutions.
• Communicate coding-related trends, issues, and best practices to coding and billing staff, providing education, training, and support as needed to improve coding accuracy and compliance.
• Stay informed about changes and updates in coding guidelines, regulations, and payer policies, and implement necessary changes to ensure compliance and optimization.
• Assist with coding audits, reviews, and compliance initiatives, identifying coding errors, patterns, and opportunities for improvement.
• Participate in coding-related meetings, committees, and projects, contributing expertise and insights to support coding and billing operations.

Qualifications

• Bachelor's degree in any Life Science field.
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or related coding certification required.
• Minimum of 2-3 years of experience in medical coding, with a focus on coding suspends and denials.

Requirements

• In-depth knowledge of CPT, ICD-10, HCPCS, and other coding systems and guidelines.
• Familiarity with coding software and systems, such as encoders, grouper software, and Electronic Health Record (EHR) systems.
• Strong analytical and problem-solving skills, with the ability to identify and resolve coding-related issues effectively.
• Excellent attention to detail and accuracy, with a commitment to maintaining high coding standards and compliance.
• Effective communication and interpersonal skills, with the ability to collaborate with multidisciplinary teams and stakeholders.
• Proficiency in medical terminology, anatomy, physiology, and disease processes.
• Ability to work independently and prioritize tasks in a fast-paced healthcare environment.
• Willingness to stay updated on coding-related trends, regulations, and best practices through continuing education and professional development.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.