Opis Senior Services Group
Coding Payment Resolution Specialist - GR
Opis Senior Services Group, Kentwood, Michigan, United States,
Job Description
Job Title : Coding Payment Resolution SpecialistLocation:
Grand Rapids, MIClient:
Trinity HealthDuration:
Full TimeBackground:Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and coding judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and determining root causes of denials.Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers, in addition to promoting departmental awareness of coding best practices. This position reports directly to the Supervisor Clinical/Coding Payment Resolution.Responsibilities:Knows, understands, incorporates, and demonstrates our client's Mission, Vision, and Values in behaviors, practices, and decisions.Provides detailed understanding or aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, regulations as directed by the Supervisor Clinical/Coding Payment Resolution.Interprets data, draws conclusions, and reviews findings with all levels of Payment Resolution Specialists for further review.Takes initiative to continuously learn all aspects of the Payment Resolution Specialist role to support progressive responsibility.Minimum Qualifications:High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four (4) years' experience within a hospital or clinic environment, a health insurance company, managed care organization, or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities, or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as normally obtained through a coding certificate program, and at least one (1) year of physician/professional or hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.Must be a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or hold a coding credential of a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.Possesses expertise in medical terminology, disease processes, patient health record content, and the medical record coding process.
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Job Title : Coding Payment Resolution SpecialistLocation:
Grand Rapids, MIClient:
Trinity HealthDuration:
Full TimeBackground:Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and coding judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and determining root causes of denials.Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers, in addition to promoting departmental awareness of coding best practices. This position reports directly to the Supervisor Clinical/Coding Payment Resolution.Responsibilities:Knows, understands, incorporates, and demonstrates our client's Mission, Vision, and Values in behaviors, practices, and decisions.Provides detailed understanding or aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, regulations as directed by the Supervisor Clinical/Coding Payment Resolution.Interprets data, draws conclusions, and reviews findings with all levels of Payment Resolution Specialists for further review.Takes initiative to continuously learn all aspects of the Payment Resolution Specialist role to support progressive responsibility.Minimum Qualifications:High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four (4) years' experience within a hospital or clinic environment, a health insurance company, managed care organization, or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities, or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as normally obtained through a coding certificate program, and at least one (1) year of physician/professional or hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.Must be a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or hold a coding credential of a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.Possesses expertise in medical terminology, disease processes, patient health record content, and the medical record coding process.
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