Claims Coding Specialist

2 weeks ago


Akron, Ohio, United States Akron Children's Hospital Full time
Position Overview:
Join our team as a Claims Coding Specialist, where you will play a crucial role in supporting the Revenue Recovery department. This position involves reviewing claims for coding precision and identifying the underlying causes of coding-related denials, while also suggesting enhancements to prevent future occurrences.

Key Responsibilities:
  • Conduct thorough retrospective account evaluations and address coding denials effectively.
  • Examine coding-related denials to uncover trends and root causes, including bundling issues and incorrect CPT/diagnoses.
  • Stay updated on relevant regulations, requirements, and best practices by engaging with industry resources.
  • Monitor EPIC work queues daily for denial management and implement necessary coding adjustments based on medical documentation.
  • Communicate with providers to resolve outstanding requests for additional documentation or diagnosis details.
  • Coordinate and complete appeals with payors as necessary.
  • Propose improvements for coding and documentation processes based on denial analysis and industry standards.
  • Generate clear reports to assist revenue recovery and revenue cycle leadership, as well as providers.
  • Collaborate with Revenue Cycle team leaders and healthcare providers to develop and implement process enhancements.
  • Deliver regular feedback and on-the-spot education to revenue recovery staff and providers to foster a deeper understanding of appropriate coding practices.
  • Perform additional duties as required.

Qualifications:
Technical Skills:
Experience in CPT and ICD coding is essential. Familiarity with all organizational levels is required. Experience with Electronic Medical Record systems is preferred, along with a background in healthcare. Proficiency in MS Office applications is necessary.

Education:
A High School Diploma or equivalent is mandatory; a Bachelor's degree is advantageous.

Certification:
Certification from AAPC or AHIMA is required.

Experience:
0 to 2 years of relevant experience is preferred.

Supervisory Experience:
No supervisory experience is necessary.

Essential Credentials:
At least one of the following certifications is required:
- American Academy of Professional Coders
- American Health Information Management Association
- Certified Provider Credentialing Specialist
- Certified Coding Specialist
- Registered Health Information Technician
- Certified Coding Associate

This is a full-time position.

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