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Description

Physician Coding & Denial Specialist
 

Summary:

• Analyzes claim denials and executes follow up to recover maximum reimbursement                     
• Performs patient billing and insurance claims filing             
• Analyzes medical records to assign appropriate diagnosis codes following coding guidelines                   
• Analyzes medical records to assign appropriate procedure codes following coding guidelines                   
• Performs analysis of medical records to rectify charge entry and modifiers based on documentation                       
• Assists with claim submission, follow-up, and reporting needs throughout the clinically-driven revenue cycle             
• Submits payer appeals as necessary and completes follow-up for final resolution               
• Assists in the clinical revenue cycle to achieve the maximum appropriate reimbursement              
• Retrieves paper and electronic claims and remittance advice reports where necessary to overcome denials            
• Enters accurate and thorough documentation of pertinent events regarding the handling of the denial                       
• Meets established production standards                    
• Works in a collaborative fashion with the office, billing, and coding staff to improve overall processes                                                                                                                                                           

Qualifications

Minimum Knowledge, Skills, Experience Required                                            

Education: High school diploma or equivalent required. Completion of Medical Coding from an approved Health Information Technology Program, currently a Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

Experience:

Minimum three (3) years working in Medical Billing & Coding.

Additional Skills / Abilities:

• Must be self-directed / self-motivated; must have good communication and interpersonal skills. 
• Must be able to: (1) perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure;  (2) work independently; (3) recognize the rights and responsibilities of patient confidentiality; (4) relate to others in a manner which creates a sense of teamwork and cooperation; and (5) maintain a customer focus and strive to satisfy the customer's perceived need.