Ambulatory Coding Expert

7 days ago


Greenville, South Carolina, United States Prisma Health Full time

We are seeking an experienced Ambulatory Coder Denials II to join our dynamic team at Prisma Health. As a key member of our Medical Group Coding & Education Services, you will play a crucial role in ensuring accurate coding and appealing denied claims.

Job Summary

This full-time, day shift position involves working closely with healthcare professionals to validate coding and facilitate appeals processes. You will be responsible for maintaining up-to-date knowledge of payer guidelines, coding software, and billing regulations.

Key Responsibilities
  • Work closely with providers to resolve coding denial issues (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 $60,000 - $80,000 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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