Coding Quality Denials Specialist

Responsibilities

• Processing & Resolution of PB Coding Denials: Serves as a subject matter expert and resource for PB Coding Denials for internal and external stakeholders.
• Validates procedural codes according to coding conventions defined by the American Medical Association’s CPT manual, CMS, including the National Correct Coding Initiative, Medicaid and other third-party payer policies as applicable.
• Validates diagnosis code according to the ICD-10 Official Guidelines for Coding and Reporting.
• Researches and resolves coding denial related issues accordingly per established EPIC Follow Up Review Work Queue functionality.
• Working knowledge of modifiers, CCI edits, HCPCS, LCD/NCDs and other applicable tools to ensure compliance with payer regulations.
• Demonstrate initiative to improve quality and customer service by striving to exceed customer expectations.
• Perform other duties as requested to facilitate the smooth and effective operations of the organization.

Qualifications

• Education: Required: High School diploma or GED
• Required: Completion of nationally recognized coding program (AHIMA/AAPC)
• PREFERRED: Associates degree/completion of a two-year Health Information Technology Program
• Experience: Required: Three (3) years professional coding experience
• Certifications/Licenses: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC)