Certified Coder Payment Recovery Specialist

About the Role

As our Payment Recovery Specialist, you will accurately review records for coding errors and correct diagnostic and procedural codes in the billing system for the purpose of reimbursement utilizing ICD-10-CM, CPT, HCPCS, and proper modifiers. You will analyze and interpret complex data, combining accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. You will identify and communicate payer and/or system trends to Management, maintain thorough knowledge of payer contracts, regulations, and guidelines, as well as state and federal laws relating to billing and collection procedures to ensure accurate and compliant billing processes.

You will communicate with courtesy and tact to fellow employees and external customers to promote better quality and more efficient customer service. Utilizing Centricity and/or related modules, you will obtain, analyze, and interpret coding denials and other reimbursement data to support compliance and billing concepts and procedures.

Responsibilities

• Manage and correct denied claims for coding issues, such as unbundling, medical necessity, and coding errors, as determined by management to facilitate payment and resolution.
• Ensure all coding error corrections accurately reflect the services provided, dates of service(s), identity of the person providing services, and that the diagnosis is accurate and carried to the highest level of specificity.
• Analyze, investigate, and follow up on denied claims.
• Manage all assigned denial work files, understand and address denials independently in a timely manner.
• Review and adhere to all Dignity Health coding policies and procedures.

Requirements

• High School Graduate.
• Three (3) years of experience in medical coding and/or billing for physician office services.
• Proficiency in assigning ICD-10-CM, CPT, HCPCS, and modifiers.
• Certification as one of the following: Certified Professional Coder (CPC), Certified Professional Coder Hospital Apprentice (CPC-HA), Certified Professional Coder Apprentice (CPCA), Certified Coding Associate (CCA), Cardiology Coding (CCC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), or Registered Health Information Administrator (RHIA).
• Ability to read and comprehend an EOB.
• Proficient in guidelines, CCI, LMRP, coding, and use of modifiers.
• Ability to research CPT/ICD-10 codes to bill appropriately.
• Proficient in all aspects of reimbursement (e.g., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials, and appeals recovery.
• Proficient understanding of medical coding systems affecting the adjudication of claims payment.

Preferred Qualifications

• Associate's degree.
• Five (5) years of experience.
• Five (5) years of work experience in medical billing and coding for physician office services.

About the Organization

At Dignity Health Medical Group (DHMG), you're not just filling a role; you're becoming an architect of healthier communities. We are the employed physician group of Dignity Health Arizona, delivering comprehensive clinical services and making a tangible difference in the lives of countless individuals. From cutting-edge diagnostics to life-changing treatments, your expertise will directly contribute to improved health outcomes.

We foster a culture of growth and innovation, advancing medicine through clinical services blended with translational and bench research. This dynamic environment augments medical education for residents and students. Our values-driven mission focuses on social justice and health equity, ensuring everyone, regardless of background, has access to high-quality healthcare. We actively work to make that a reality.

We believe in building a strong, inclusive team where everyone feels valued and respected. If you're deeply committed to social justice, health equity, and delivering care in new, innovative ways, your values align perfectly with ours.

Pay

$24.33 - $36.19 per hour.