Processes and appeals claims denied for coding or medically necessary related reasons. Facilitates accurate coding by providing feedback related to payor denials and policies to coding personnel.
Hiring range: $22.87 to $30.25. Placement in the range is dependent on relevant experience and certification.
Essential Responsibilities:
- Thoroughly and timely work follow up records related to coding and medical necessity denials in work queues as defined by policies and procedures.
- Review documentation for coding accuracy and make appropriate corrections.
- Research payor policies and guidelines to accurately appeal denials, submit correct claims, adjust charge balances and/or transfer the claim balance to the patient (NRP).
- Identify patterns and provide feedback to leadership to improve coding and reduce denials.
- Document account activity accurately and promptly during or immediately following each processed encounter.
- Attend training sessions as requested.
- Present unresolved concerns to Supervisor for resolution immediately with related documentation.
SKILLS AND ABILITIES:
- Ability to interpret insurance medical policies and procedures.
- Demonstrated understanding of standard insurance reimbursement methodologies.
- Knowledge of medical terminology and anatomy required.
- Time management skills.
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent required.
- Minimum of one year experience in medical billing and collections, or coding. Education in the form of a certificate, associate’s degree or higher in Medical Billing and Coding alternatively accepted.
- Experience with ICD-10, CPT, and HCPCS coding and Correct Coding Initiatives (CCI) required.
- Certifications preferred: AHIMA (CCA, CCS, CCS-, or RHIT); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the relevant AAPC specialty-specific coding credentials).
- Experience with government, commercial, and third party insurance contract practices and claims processing procedures preferred.
The above information is intended to indicate the general nature and level of work required in this position. It is not designed to contain or be interpreted as a comprehensive description of all duties, responsibilities, and qualifications required of those assigned to this job.
Vancouver Clinic is proud to be an Equal Opportunity Employer. Vancouver Clinic does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, gender identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Vancouver Clinic is an alcohol and drug-free workplace. Offers are contingent on successful completion of background screen and immunization requirements.
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