Physician Services – Lead Coding, Billing & Appeals - Sherloq Solutions

Teleworking Available

Sherloq Revenue Solutions of Tampa, FL is looking to hire a full-time Coding Specialist, Insurance Revenue Cycle. Are you looking to work for a high-energy, fast-paced company that fosters a team environment? Do you want to work where you will be respected and valued for what you contribute? An organization with a long history in the community for over 100 years! Well, you found it. Sherloq Revenue Solutions is looking to enhance our team with top performers who are knowledgeable in the Healthcare Revenue Cycle. We are seeking candidates with experience from healthcare providers or insurance payers that are looking to maximize their skills in the industry.

This position earns competitive pay, depending on experience. We value our employees and offer amazing benefits, including medical Insurance, a 401(k) plan, generous vacation and paid-time-off (PTO), eight paid holidays, and tuition reimbursement as well as life, dental, accidental death & disability, and supplemental insurance. Our plans are designed to be both valuable and affordable.
 If this sounds like the right opportunity in healthcare billing for you, apply today!

JOB SUMMARY

This position will require the employee to review coding errors, make recommendations, and coordinate with providers for resolution of healthcare claims. Almost all of the claims that require review will have already been submitted and rejected or denied by health insurance payer. Position will involve resolving coding denials such as inclusive, not medically necessary, LCD/NCD issues, and modifiers. Other tasks include submission of clean claims electronically or by paper and creating and submitting appeals with supporting documentation to health insurance payers.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Analyze and clarify all levels of coding denials and take or request appropriate action for correction or dispute.
• Resolve healthcare claims through coordination of coding error resolution and billing and appeal submissions to health insurance payers.
• Effectively navigate and utilize various healthcare provider software systems.
• Verify patient, insurance, billing and claim submission information for accuracy and make the needed corrections.
• Secure and submit the required documents per insurance request.
• Utilize information provided by Revenue Cycle Specialists to provide a second level claim review.
• Formulate reconsideration or appeal response letters to the insurance providing all supporting documentation to expedite revenue recovery.
• Track trends in payer underpayments, coding issues and denials and report to leadership for escalation.

SKILLS

• Excellent verbal and written communication skills.
• Accurately read and interpret insurance explanation of benefits.
• Working knowledge of anatomy and medical terminology.
• Computer proficiency with Microsoft Word, Excel, Outlook and other office software applications is required.
• Ability to problem solve and think critically to identify trends.
• Work well with others and promote a team environment.
• Utilize time management skills to manage daily tasks and meet production & quality metrics.

EDUCATIONAL REQUIREMENTS

• One (1) year of verifiable coding experience in ICD-10 and CPT. Coding experience with Revenue Codes and HCPCS preferred.
• Three (3) years of healthcare industry experience preferred.
• Associates degree preferred, high school diploma or equivalent required.
• A background in healthcare claims billing, insurance collections, coding, and/or denials management is desired.
• Obtain AAHAM Certified Revenue Cycle Specialist accreditation within two years of employment. Other similar industry certifications accepted.
• RHIA, RHIT, CCS, or CPC Certification. CPC-A accepted, with CPC obtained within two years of original CPC-A status.
• Continue to maintain accreditation throughout employment with certification required additional educational units.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, or national origin.

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