Job Details

Inspire health. Serve with compassion. Be the difference.

Job Summary
Will consider applicants that only have a CPC certification and qualify only for Ambulatory Coder II position, PF0068.

Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. All team members are expected to be knowledgeable of payer guidelines related to coding and appeal timelines. Communicates with providers regarding coding denial issues. Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc. Serves as a subject matter expert for assigned specialty. Communicates with providers and team members regarding coding denial issues and trends.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals.
• Utilizes appropriate coding software and coding resources in order to determine correct codes.
• Communicates billing related issues to assigned supervisor/manager.
• 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.
• Assists in identifying areas that need additional training
• Participates in meetings to improve overall billing process
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School Diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred
• Experience - Five (5) years professional coding and/or billing experience

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• Certified Professional Coder -CPC
• CPMA or Specialty Coding Certification for assigned specialty

Knowledge, Skills and Abilities

• Maintains knowledge of governmental and commercial payer guidelines.
• Participates in coding educational opportunities (webinars, in house training, etc.).
• Knowledge of office equipment (fax/copier)
• Proficient computer skills including word processing, spreadsheets, database
• Data entry skills
• Mathematical skills

Work Shift
Day (United States of America)

Location
Independence Pointe

Facility
7001 Corporate

Department
70019178 Medical Group Coding & Education Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.