Medical Coder Specialist

6 days ago


Greenville, South Carolina, United States Prisma Health Full time

Transform healthcare with Prisma Health. We're seeking a skilled Ambulatory Coder Denials II to join our team.

About the Role

This full-time, day shift position is responsible for validating coding and facilitating appeals processes for denied professional service claims. The ideal candidate will possess knowledge of payer guidelines, coding software, and billing regulations.

Key Responsibilities
  • Accurately and timely resolve coding claim denials in accordance with performance goals (40%);
  • Utilize coding software and resources to determine correct codes (15%);
  • Familiarize yourself with departmental policies for charge corrections (5%);
  • Participate in coding educational opportunities (webinars, in-house training) (5%);
  • Provide timely feedback to providers or office liaisons on coding concerns (5%);
  • Submit appeals for assigned payers and/or divisions (5%);
  • Maintain knowledge of governmental and commercial payer guidelines (5%);
  • Assist Compliance Team and Coding Educators in identifying areas requiring additional training (5%);
  • Communicate billing-related issues to assigned supervisors/managers (10%);
  • Participate in A/R Meetings to improve overall billing (5%).
Requirements
  • High School diploma or equivalent;
  • Associate degree - preferred;
  • 2 years of professional coding or combination of coding/billing experience;
  • Certified Professional Coder-CPC certification;
  • Basic computer skills, including word processing, spreadsheets, database, and data entry.
Location and Benefits

This role is based at Independence Pointe, 7001 Corporate, with a salary range of $55,000 - $70,000 per annum, depending on experience. Our comprehensive benefits package includes medical, dental, and vision insurance, as well as paid time off and holidays.



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