Revenue Integrity Coder

Overview

Remote coding position that is responsible for coding denial follow up work queues and appeals processing for FHPG for multi-speciality providers.

Responsibilities

Responsible for denial and appeals claim processing for medical providers, and laboratories services ordered by FHPB, ensuring compliance and contractual obligations and State and Federal laws and regulations and generating appeals for denied or underpaid claims

Analyze all coding adjustments made on EOB to ascertain accuracy and validity. Determine and execute best approach for denial resolution and processing appeals in accordance with Federal, State and payer guidelines,

Ensure timeliness of appeals, generate appeals based on dispute reason(s), request and obtain medical records as needed for appeal, document all actions taken during the appeal process and any required follow up.

Assist manager in identifying coding errors that generate denials and help to establish front end charge review edits to decrease denials.

Review claims with 22, 52 & 53 modifiers in the claims requiring attachments work queue, initiate request of records utilizing EPIC software, submit required documentation for claim following payer requirements.

Work with Assist Dir of Speciality Coding & Revenue Integrity to utilize workflows set in place to minimize late charges, optimize revenue capture and identify trends within clinic areas that need attention.

Assist with Pre-AR coding as needed.

Qualifications

Education / formal training / licensure / certifications / experience

Prefer Bachelor Degree in Business, Healthcare Administration or Information Systems; experience may be accepted in lieu of education or formal training. Three years experience in physician group practice that utilizes EMR and Billing systems to performed daily activities. Greater than three years' experience in Clinic Practices and Clinic Billing. Certification in Coding either CPC or CCS-P.

Additional Skills

Knowledge of PC's and MS-Windows. Strong communication and interpersonal skills. Strong problem-solving skills. Analytical ability needed to understand system processes and troubleshoot system issues. Proficient in electronic spreadsheet and database applications. Payer billing and coding knowledge.

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