Certified Professional Coder I

Role Overview

• Analyzes coding and the denial information for the claim to identify coding issues that caused the denial on unpaid claims and determines next steps for recovery.
• Creates detailed appeal letters for denials from payer to support payment of patient claims.
• Makes recommendations to client for corrections or changes to the claim based on LCD/NCD policies (local coverage and national coverage), individual payer medical policies and coding guidelines.
• Reviews and verifies that diagnosis codes on bills adhere to the patients' medical records for purpose of reimbursement.
• Reviews and verifies that inpatient DRG codes billed on claim is supported by the diagnosis billed and adhere to the patients' medical records for purpose of reimbursement.
• Assist Knowtion Health team members by providing coding review feedback in gathering supporting documentation to submit appeals.

Requirements

• Certified Professional Coder certification
• Minimum of 2 years experience working for a hospital or payer or in a customer service position
• Preferred experience includes healthcare insurance billing and/or follow up for hospitals
• medical coding
• claim adjudication
• patient accounting
• payer adjuster
• filing and/or settlement of accident claims (motor vehicle or workers compensation)
• other experience as determined based on the program.

Benefits

• medical
• dental
• vision
• life insurance
• short term disability
• long term disability
• paid holidays
• 401k
• generous PTO policy