Surgical Coding Denials Specialist (FT, PT, and Contract Positions)

The Remote Coding Denials Specialist- Pro Fee must be proficient in working denials for multispecialty coding, along with E&M coding for all places of services.  Will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. The coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets.  The coder scope will involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.   

Qualifications

• CPC or CCS certification required
• At least 2 years of active E&M and Surgical Coding experience required.  Surgical Coding Experience in the following specialties is required: General Surgery, OB, and/or Trauma. This team member will be responsible for working complex surgical coding denials. 
• Must possess a comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding
• Knowledge and experience in dealing with third party insurance companies relative to claim processing and coding denials follow up
• Epic Resolute experience helpful

Responsibilities

• The Claim and Denial Coding Analyst role is a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, .
• Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process
• Maintain current knowledge of coding, compliance, and documentation guidelines
• Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
• Resolve coding denials through claim correction or appeal
• Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications
• Report high volume coding denial trends to the coordinator
• Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues
• Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations
• Seeing as it relates to general and near vision