About this role
Role Overview
- Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims
- Communicates with providers regarding coding denial issues
- Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals
- Serves as a subject matter expert for assigned specialty
- Communicates with team members regarding coding denial issues and trends
- Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals
- Follows departmental policies for charge corrections
- Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns
- Submits appeals for assigned payer and/or division
Requirements
- High School Diploma or equivalent
- Five (5) years professional coding and/or billing experience
- Certified Professional Coder -CPC
- CPMA or Specialty Coding Certification for assigned specialty
- Knowledge of governmental and commercial payer guidelines
- Proficient computer skills including word processing, spreadsheets, database
- Data entry skills
- Mathematical skills
Benefits
- Inspire health
- Serve with compassion
- Be the difference