Coding and Claims Resolution Specialist
2 weeks ago
At St. Luke's Hospital, we take pride in the expertise, dedication, and empathy of our workforce. Our employees are our greatest asset, committed to fulfilling our mission of excellence in caring for the ill and injured, educating healthcare professionals, and enhancing access to care in our communities, irrespective of a patient's financial situation.
The Coding and Claims Resolution Specialist position involves a Certified Medical Coder responsible for ensuring accurate claim submissions and the prompt review and resolution of coding-related claim denials for professional services across various healthcare settings. This role requires the utilization of provider documentation, coding software tools, and insurance carrier policies during the claims review process.
KEY RESPONSIBILITIES:
- Stay updated on coding, compliance, and documentation standards.
- Address Charge Review and Claim Edit CCI/LCD edits, rectify diagnosis coding errors, and manage MUE frequency for successful claim submissions.
- Resolve coding denials through claim adjustments or appeals, collaborating with relevant stakeholders to formulate a rationale based on clinical documentation and applicable guidelines.
- Provide coding support to healthcare providers and charge entry personnel for minor errors, while reporting trends in high-volume coding denials.
- Maintain detailed documentation, spreadsheets, and examples of root cause issues, while researching guidelines to identify coding and billing requirements for recommendations.
- Review TCM Charge Review encounters to ensure documentation meets all necessary TCM components, adjusting service levels as required.
- Participate in coding conferences, workshops, and training sessions to stay informed about updates in coding practices and regulations.
- Assist in onboarding new staff members in all aspects of the Analyst role.
PHYSICAL AND SENSORY REQUIREMENTS:
Ability to sit for extended periods, with occasional standing and walking. Frequent use of hands for typing and handling documents, with occasional bending and reaching required. Good hearing and vision are essential for effective communication and document review.
EDUCATION:
CPC or CCA certification is mandatory.
TRAINING AND EXPERIENCE:
A minimum of 2 years of active E&M and/or Surgical Coding experience is required. Comprehensive knowledge of ICD-10-CM, CPT, and HCPCS coding is essential, along with experience in interacting with third-party insurance companies regarding claim processing and coding denials. Familiarity with Epic Resolute is advantageous.
We encourage candidates to complete their applications thoroughly, including all relevant work history and qualifications. Thank you for considering a career with St. Luke's Hospital.
St. Luke's Hospital is an Equal Opportunity Employer.-
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