Duties and Responsibilities:
Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse. Creates appropriate letters to substantiate the validity of claims.
Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up. Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty. Works directly with facility liaison or other clinical staff as needed to provide documentation feedback and to develop appeals.
Researches payer policies and processes.
Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment.
Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed. Identifies invoices or claims that have been rejected per billing edits/criteria.
Knowledge, Skills, and Abilities:
Knowledge of ICD-10 and CPT Coding
Must be comfortable working with AR teams to resolve issues.
Must be able to pass a coding assessment.
Must be proficient in Microsoft Office, including Outlook, Excel, and Teams.
Ability to multi-task and have excellent communication skills.
Must meet and maintain a 95% quality accuracy rate and productivity standards.
Must be able to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics.
Must have experience working in a remote environment.