Sentara Healthcare Inc

Claims Resolution Coder- Remote Responsible for reviewing medical documentation to assign modifiers to insurance claims with issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE),or other party payer specific claims processing guidelines. Works with Coding, Billing and Reimbursement staff to resolve edits. Is additionally responsible for trending errors, supporting identification of root causes, and effective communication with coding and training staff to improve coding accuracy and clean claims processing. Researches regulations to ensure accuracy of CPT codes and documentation. Associates degree in Health Information Technology or Medical Billing preferred. 2 years direct application of coding, medical billing or reimbursement in health care setting, hospital or physician office required. CPC or CCS coding certification required at time of hire. Thorough knowledge of lab, radiology and other ancillary, CPT, HCPCS related...

Position SummaryCodes inpatient accounts applying appropriate ICD-10-CM / ICD-10-PCS / CPT-4 codes for hospital reimbursement, mortality & morbidity outcomes, research & statistical and regulatory compliance.Abstracts, codes and assigns necessary demographic and clinical data elements required for inpatient records.Effectively utilizes encoder software to assure appropriate reimbursement and accurate DRG & MSDRG assignment.Completes all work in accordance with defined productivity and quality standards.As necessary, consults or queries the physician for additional information or clarification of diagnoses, co-morbid / secondary conditions, and procedures.Provides physicians education on coding, documentation and medical necessity requirements.Assures optimal ethical reimbursement for coded encounters and assures coding practices fall within established compliance guidelines.Uses concurrent documentation database to accurately reflect queries and updates to DRG...