PB Coding Integrity Specialist - Primary Care Specialties

• Family Practice

• Monday - Friday 1st shift 40 hours a week with ability to pick start time after training.  Hours will need to be between 5am to 7pm.

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).

• Second Specialty credential preferred.

• Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

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  Analyze and resolve coding-related PB and HB denials using CPT, HCPCS, ICD-10-CM, and modifiers. 

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  Identify root causes, patterns, and trends in denial and rejection codes. 

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  Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims. 

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  Conduct chart reviews to validate documentation against billed services. 

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  Prepare and support appeals by researching payer guidelines, coding standards, and coverage policies. 

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  Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements. 

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  Track, document, and report denial resolutions, appeal outcomes, and coding quality issues. 

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  Support compliance, quality assurance, and revenue integrity initiatives through issue monitoring and escalation resolution. 

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  Educate clinicians, coders, and staff by sharing findings and supporting targeted training based on denial trends. 

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  Contribute to operational and strategic initiatives, including denial avoidance strategies, work queue optimization, CARC code mapping, and technology-driven improvements.  

• Position requires travel which will result in exposure to road and weather hazards. 

• Operates the equipment necessary to perform the job. 

• Exposed to a normal office environment. 

• Associate degree or equivalent education and experience required. 

• Coding credential required. A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant experience. 

• 4 years of experience in expert-level professional coding or hospital-based coding and experience in revenue cycle processes, health information workflows, and medical record auditing experience   

• Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems. 

• Advanced knowledge of medical terminology, anatomy, and physiology. 

• Advanced ability to identify coding discrepancies and provide recommendations for improvement 

• Advanced ability to analyze trends and data and display them in a statistical reporting format. 

• Advanced knowledge of care delivery documentation systems and related medical record documents.  

• Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines. 

• Advanced knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications. 

• Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments. 

• Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment. 

• Advanced analytical skills, with great attention to detail. 

• Self-motivated with initiative and strong sense of ethics. 

• Ability to work independently and exercise independent judgment and decision making.  

• Ability to meet deadlines while working in a fast-paced environment. 

• Strong organizational skills and ability to work independently with limited guidance or direction. Effective critical thinking, creativity, problem solving and decision-making skills. 

• Second Specialty credential preferred 

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.