Coding Specialist

About the Role

The Coding Specialist has knowledge of RCM denial management to resolve coding-related third party payor denials. Coding Specialists increase and expedite service revenue, reduce aged AR, and trend denials for their root causes, driving efficiencies including documentation improvement and coding denials prevention.

Responsibilities

• Performs front-end review of client documentation to ensure it supports the requested services.
• Reviews requisitions to ensure the claim is billed accurately.
• Analyzes invalid denial trends, payer-specific carrier submission requirements, and system optimization.
• Performs retrospective coding and documentation review of denied charges.
• Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and meets all documentation standards for billing; works with referring providers to obtain additional information as needed.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Ensures denial reviews are conducted on time.
• Participates in annual and ongoing mandatory employee training.
• Fulfills Continuing Education Units necessary to maintain certification status.
• Meets productivity standards, identifies any issues or trends, and brings them to the attention of management.
• Demonstrates excellent interpersonal, verbal, and communication skills.
• Follows coding guidelines and legal requirements to ensure compliance with institutional, federal, and state regulations.
• Demonstrates the ability to function independently and use critical thinking and analytical skills.
• Performs all job responsibilities in alignment with industry best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including Privacy and Security policies.
• Works with other departments within PathGroup and subsidiaries.
• Performs other duties as assigned.