Claims and Coding Denial Analyst

United States·Allentownmid

Other

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Quick Summary

Key Responsibilities

Maintain current knowledge of coding, compliance, and documentation guidelines Resolve Charge Review and Claim Edit CCI/LCD edits,

Technical Tools

Other

Responsibilities

~2 min read

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Maintain current knowledge of coding, compliance, and documentation guidelines
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Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
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Resolve coding denials through claim correction or appeal. Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator. Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance
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Provide coding guidance to providers and charge entry staff for single or low volume errors. Report high volume coding denial trends to the coordinator
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Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations
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Review TCM Charge Review encounters to verify the documentation supports all required TCM components. Relevel TCM service when not supported by the documentation or TCM has been rendered during another TCM 30-day period
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Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations
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Assists with training new staff in all aspects of the Analyst role.

Requirements

~1 min read

Sitting for up to 8 hours per day, 3 hours at a time. Standing and walking as necessary. Fingering and handling frequently, twisting and turning of hands occasionally. Pushing and pulling. Occasionally stoops, bends, squats, kneels and reach above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general and near vision.

CPC or CCA certification required.

At least 2 years of active E&M and/or Surgical Coding experience required. Must possess a comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding. Knowledge and experience in dealing with third party insurance companies relative to claim processing and coding denials follow up. Epic Resolute experience helpful

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!