Coding Specialist, Denials - United Surgical Partners International

Position Overview:

Reporting to the Coding Manager, this position is responsible for utilizing reimbursement and coding knowledge to resolve outstanding medical claims that are pended or denied for various coding reasons specific to government and commercial payers.

Responsibilities:

• Manage daily coding email queues providing responses within 3 business days.
• Investigate and resolve coding related denials from payers resulting in claim reimbursement.
• Identify documentation and coding guidelines or regulations to defend the claim as billed or support the payer’s denial for corrections needed.
• Responsible for formulating reportable data into trends that can be utilized to develop process improvements. This includes but is not limited to the tracking of all coding queries, denials, and reimbursement outcomes.
• Ability to analyze all aspects of patient’s medical records to locate documentation to support medical necessity.
• Additional duties as assigned.

Requirements:

• RHIA, RHIT, CPC, or CCS certification required.
• Must have knowledge of AMA, CMS, and CPT coding guidelines.
• Knowledge of ICD-10-CM, medical terminology, anatomy & physiology.
• 2 years of ASC revenue cycle or coding experience.
• High School diploma or equivalent.
• Ability to maintain required productivity and accuracy standards.
• Excellent verbal and written communication skills.
• Ability to prioritize workload, handle competing priorities, while meeting or exceeding deadlines.