Coder Lead (Denials) Are you looking for a rewarding career with a top-notch health care company? We're looking for a qualified Coder Lead (Denials) like you to join our Texas Health family.
Position Highlights Work location: Remote work
Work hours: Monday - Friday generally between 7:00 am - 6:00 pm
HIMS Coding Department Highlights: Flexible hours/scheduling once training is complete
Work life balance
Opportunities for advancement
Here’s What You Need Education H.S. Diploma or Equivalent REQUIRED and
Bachelor's Degree Related field. 4 Years Coding, denials, and/or AR experience in lieu of degree REQUIRED
Experience 5 Years Coding and/or Denials experience REQUIRED
Licenses and Certifications CPC - Certified Professional Coder Upon Hire REQUIRED or
CCS-P - Certified Coding Specialist - Physician-based Upon Hire REQUIRED
Other Specialty certification such as CGSC, COSC, CCC, CPB, CPPM, CHONC, CFPC, CPMA, etc. Upon Hire preferred
Skills Extensive understanding of health insurance and medical coding requirements.
Extensive knowledge of third party billing regulations, professional operations, and third party payer requirements.
Must possess strong written & verbal communication skills, good interpersonal skills.
Must be detail oriented and have strong organizational skills.
Must possess a strong work ethic and a high level of professionalism.
Must have advanced computer skills (e.g., Excel, Power Point, Word, Outlook, OneNote, SharePoint), with the ability to learn potential new internal application systems. (e.g., computerized coding tools)
Must possess strong analytical, research & reporting skills
Must be comfortable leading people/demonstrating leadership qualities in alignment with THPG promise behaviors
What you will do In compliance with established guidelines, reviews supporting documentation to ensure accurate coding assignments (ICD, CPT, HCPCS) in support of third party payer, NCCI guidelines and THR/THPG policies. Maintains documentation to record/track discrepancies for applicable provider specialties. Monitor and assist charge capture and/or denial coding staff as needed. Monitor CRD charge capture/denial WQs and assist in resolving system issues preventing charges from clearing the WQs (e.g. misrouting, charges not dropping, edits not functioning as expected).
Monitor coding discrepancy logs to identify trends impacting coding. Performs root cause analysis and creates action plans for issues impacting coding quality or established KPI metrics. Participates in special projects and completes other duties as assigned. 25%
Serves as a subject matter expert, providing direction to less experienced staff. May assist with training, auditing, and/or reviewing productivity and quality rates under the leadership of department management.
Respond to requests for assistance from inter‑departmental teams, external vendors, providers and operations as well as addressing escalated questions pertaining to coding and quality distribution lists.
Process requests to force override system held charges, charge corrections, void charges, merge charges, deferred charges and write offs.
Support designated meetings when required by department management (e.g., Optimization, Edits, Lab, Denial, Payor Escalations, CRD Policy & Procedures, etc.) by preparing documentation, communicating updates, minutes, following action items and/or serving as proxy.
Additional perks of being a Texas Health Coder Lead Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits.
A supportive, team environment with outstanding opportunities for growth.
Explore our Texas Health careers site (https://jobs.texashealth.org/) for info like Benefits (https://jobs.texashealth.org/benefits) , Job Listings by Category (https://jobs.texashealth.org/professions) , recent Awards (https://jobs.texashealth.org/awards) we've won and more.
Feel free to email your questions to recruitment@texashealth.org .
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Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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