Claim and Denials Coding Analyst

2 months ago

Allentown PA United States St. Luke's University Health Network Full time


St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

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, FQHC, MSO, and ASCs across the network. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process.

JOB DUTIES AND RESPONSIBILITIES:

  • 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. The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator. Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance

  • Provide coding guidance to providers and charge entry staff for single or low volume errors. 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

  • Review TCM Charge Review encounters to verify the documentation supports all required TCM components. Relevel TCM service when not supported by the documentation or TCM has been rendered during another TCM 30-day period

  • Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations

  • Assists with training new staff in all aspects of the Analyst role.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for up to 8 hours per day, 3 hours at a time. Standing and walking as necessary. Fingering and handling frequently, twisting and turning of hands occasionally. Pushing and pulling. Occasionally stoops, bends, squats, kneels and reach above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general and near vision.

EDUCATION:

CPC or CCA certification required.

TRAINING AND EXPERIENCE:

At least 2 years of active E&M and/or Surgical Coding experience required. 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

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's



St. Luke's University Health Network is an Equal Opportunity Employer.

  • Claims and Denial Coding Analyst

    1 week ago

    Allentown, PA, United States St. Luke's University Health Network Full time

    St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other...

  • Claims and Denial Coding Analyst

    4 weeks ago

    Allentown, United States St. Luke's University Health Network Full time

    St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other...

  • Claims and Denial Coding Analyst

    1 week ago

    Allentown, United States St. Luke's University Health Network Full time

    St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other...

  • Medical Coding Specialist

    3 weeks ago

    Allentown, Pennsylvania, United States St. Luke's University Health Network Full time

    Job Summary:The Claim and Denial Coding Analyst role is a critical position at St. Luke's University Health Network, requiring a Certified Medical Coder who ensures clean claim submission and timely review and resolution of coding-related claim denials for professional services, FQHC, MSO, and ASCs across the network.Key Responsibilities:Maintain current...

  • Medical Coding Specialist

    3 weeks ago

    Allentown, Pennsylvania, United States St. Luke's University Health Network Full time

    Job Summary:The Medical Coding Specialist will ensure accurate and timely coding of medical records for professional services, FQHC, MSO, and ASCs across the network. This role requires a Certified Medical Coder who can utilize provider documentation, coding software tools, and insurance carrier medical and reimbursement policies during the claim review...

  • RCM Denial Claims Analyst Lead

    2 days ago

    West Long Branch, NJ, United States Allied Digestive Health Full time

    Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our...

  • Claims Analyst

    2 weeks ago

    Fort Lauderdale, FL, United States Nova Southeastern University Full time

    Join Our NSU Health Team as a Claims AnalystAre you detail-oriented, analytical, and passionate about ensuring the accuracy and efficiency of healthcare claims processing? At NSU Health, we’re looking for a dedicated Claims Analyst to join our team and play a vital role in optimizing our revenue cycle. This position offers a chance to make a meaningful...

  • Revenue Cycle Denials And Appeals Specialist

    3 weeks ago

    Charlotte, NC, United States TEKsystems Full time

    Description:The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes...

  • Revenue Cycle Denials And Appeals Specialist

    3 weeks ago

    Charlotte, NC, United States TEKsystems Full time

    Description:The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes...

  • Medicaid Claims Specialist

    4 weeks ago

    Allentown, Pennsylvania, United States Phoebe Ministries Full time

    Medicaid Analyst Job DescriptionPhoebe Ministries is seeking a skilled Medicaid Analyst to join our team in Allentown, PA. As a Medicaid Analyst, you will play a crucial role in ensuring accurate and timely billing for our long-term care facility.Key Responsibilities:Enter PA162's/MA Approvals for Medicaid Fee for Service and Community Health Choices MA...

  • ESIS Claims Representative, AGL

    2 weeks ago

    Philadelphia, PA, United States Chubb Full time

    ESIS - Auto & General Liability Claims Representative - PIP Adjuster ESIS recognizes each risk management program is unique, and we are committed to providing consultative and innovative solutions to drive superior results. Our culture and vision enables us to effectively operate as an extension of our clients’ risk management program, aligning combined...

  • Coding and Medical Records Auditor

    1 day ago

    Franklin, TN, United States TruHealth LLC Full time

    JOB SUMMARY: TruHealth is the clinical arm of the health plan and supplies the model of care. The Coding and Medical Records Auditor will be responsible for conducting coding audits prior to claims submission. This position will ensure appropriate and accurate coding is applied for each member of the plan. Additionally, post-payment coding reviews may be...

  • Claims Analyst

    2 weeks ago

    New Brunswick, NJ, United States Proficient Auto Logistics Full time

    Job descriptionTribeca Automotive is a leader in the auto transportation industry. We are seeking a detail-oriented Claims Analyst to join our dynamic team. This position supports the Claims Department by analyzing, adjusting, and resolving auto damage claims.DutiesReceives, reviews and acknowledges cargo claims damage notifications and FNOL in a timely...

  • Coding and Medical Records Auditor

    2 weeks ago

    Franklin, TN, United States TruHealth LLC Full time

    JOB SUMMARY: TruHealth is the clinical arm of the health plan and supplies the model of care. The Coding and Medical Records Auditor will be responsible for conducting coding audits prior to claims submission. This position will ensure appropriate and accurate coding is applied for each member of the plan. Additionally, post-payment coding reviews may be...

  • Coding and Medical Records Auditor

    10 hours ago

    Franklin, TN, United States TruHealth LLC Full time

    JOB SUMMARY:TruHealth is the clinical arm of the health plan and supplies the model of care. The Coding and Medical Records Auditor will be responsible for conducting coding audits prior to claims submission. This position will ensure appropriate and accurate coding is applied for each member of the plan. Additionally, post-payment coding reviews may be...

  • Medical Billing and Coding Specialist

    4 weeks ago

    Vernon Hills, IL, United States GPAC Full time

    Medical Billing and Coding Specialist's needed! We are seeking a detail-oriented and organized Medical Billing and Coding Specialist to join our team. You will be responsible for accurately preparing and submitting medical claims to insurance companies and ensuring timely reimbursement. Your attention to detail and knowledge of medical billing codes and...

  • Epic Claims Analyst

    2 weeks ago

    Philadelphia, PA, United States Hire IT People, Inc Full time

    We are hiring for below Epic Claims Analyst/lead role in Philadelphia 19124 (North Philly) free parking on Hybrid (Monday and Friday WFH, Tuesday-Thursday in the office) basis for a long-term contract of12-months with potential extensions.Interview Process: virtual 1 and done and they set them up within a day of sending candidates over Responsibilities:This...

  • Senior Claims Analyst, GL

    1 week ago

    Rockville Centre, NY, United States The RiverStone Group Full time

    Description Senior Claims Analyst, GL - New York Labor Law Full-time Remote & Hybrid Opportunities Available It's an exciting time to join Rockville Rockville, a wholly owned subsidiary of the RiverStone Group, is a growing third-party claim administrator, setting a new standard of service excellence in the insurance services industry. We handle...

  • Analyst, Finance

    1 week ago

    Merrillville, IN, United States Motion Recruitment Full time

    Title: Analyst - IntermediateType: Contract, 3 Months to Start, Potential to ExtendLocation: Hybrid Schedule - Tues/Wed Onsite in Merrillville; Mon/Thurs/Fri are remoteCST Hours: 6:00 AM - 2:30 PM with a 30 Minute BreakOur client, one of the largest U.S. utility companies, is seeking a talented Analyst for their finance organization. This individual will...

  • Epic HB Claims Analyst

    2 weeks ago

    Rockville Centre, NY, United States Insight Global Full time

    **Must be local to Tri-state areas to come onsite for go-lives**Must-haves * 5+ years of experience working within Hospital Billing * Epic certification in Hospital Billing (HB) *Epic HB Claims & Claims form build*Experience with charge router build* Strong knowledge of revenue cycle processes and healthcare workflows. Day-to-Day A leading hospital system...