Job Details

Department:

13245 Enterprise Revenue Cycle - Professional Coding Denials Integrity

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First Shift

Remote

Desired Experience: Medical Specialties

Pay Range
$26.10 - $39.15

Major Responsibilities:

• In collaboration with Customer Service, analyze and resolve professional coding complaints in a timely manner using correct coding and payer guidelines to ensure patient satisfaction.
• Identifies and analyzes coding denials for a specific population of charges and works in collaboration with the Production Coding team. Coordinates coding rejection data collection activities used for reporting and accountability tracking. Identifies potential trends or knowledge concerns and opportunities for improvement and prevention.
• Researches and documents applicable regulatory, coding and billing rules. Develops standardized processes and tools for the coding production team to utilize when dealing with insurance rejections and recommendations to avoid future denials.
• Works with Professional Coding Leadership to develop monthly coding update reports to continually educate and communicate coding related recommendations based on monthly findings. Maintains up-to-date information regarding coding denials and rejections and communicates the changes accordingly.
• Identifies and problem solves trends and issues. Collaborates with department leadership clinic operations managers, system contracting team to determine preventative measures, follow-up and resolve these issues. Communicates with and acts as a resource for others regarding coding and appeal issues.
• Provides regular statistical reports to leadership regarding rejection/denial volumes, response timeliness, success rates, identified trends, and recommendations to prevent future coding rejections/denials.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally (i.e., NCD, LCD) accepted coding policies and standards. Develops expertise in coding for assigned specialties. Communicates and reinforces changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinates necessary modifications and updates appropriately.
• Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding based on CPT, ICD-10 CM/PCS, HCPCS in accordance with coding and payer guidelines.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC).

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required:

• Typically requires 5 years of professional coding and at least 3 years of payer background experience in physician revenue cycle processes, health information workflows and reimbursement in a large, complex clinic or medical group.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines.
• Advanced of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents. Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced computer skills including the use of Microsoft Office, email and exposure or experience with electronic coding systems or applications.
• Proficient interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Excellent organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Excellent analytical skills, with a great attention to detail.
• Ability to work independently and exercise independent judgment and decision making. Ability to meet deadlines while working in a fast-paced environment.

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#REMOTE

#LI-REMOTE

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.