Physician Based Coder (Profee)

Physician Based Coder (Pro fee) Must have strong Physician Based, Pro fee Experience

• Must be a certified coder (CPC, CCS, RHIA,RHIT)
• Must have Epic EMR systems experience
• 100% Remote position - Monday-Friday 40 hrs per week(flexibility in shifts)
• Long-term temp Assignment - Possibility of perm hire
• $25 per hour (non-negotiable)

We are seeking a skilled professional to provide guidance and support to our coding team. This role involves ensuring prompt coding and charge entry, assessing performance, and identifying training needs. You will play a key role in maintaining adherence to established policies and procedures and supporting disciplinary actions when necessary. Position Summary This role is responsible for analyzing coding denials by insurance carriers, CPT code(s), and specialty area, review and submission of coding appeals related to denials to include coding, bundling, duplicate, and other assigned denial volume. As well as responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims and accounts. Perform detailed analysis on denied assigned claims with a focus on maximizing revenue and reimbursement. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process.

Responsibilities

• Review and analyze coding, bundling, and duplicate denials including identification of root cause.
• Resolve coding denials which include researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation.
• Analyzing assigned denials and making necessary corrections or modifications.
• Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
• Identify and provide coding denial trends by Payer, CPT code, or any other denial parameters.
• Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations.
• Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials.
• Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission.
• Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness.
• Partners with revenue cycle leadership, peers and clinical operations to reduce denials.
• Reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes.
• Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals.
• Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations.
• Develop process improvement initiatives from which problems can be resolved.
• Documents results of all special projects and provides recommendations for revenue managing opportunities.

Minimum Requirements

• Minimum of bachelor's degree or higher in a health service-related discipline.

Five years of denial recovery experience or revenue cycle related field with a certificate in coding may be substituted.

• Previous auditing experience preferred.
• National Certification in an area relevant to Revenue Management or Coding is preferred.
• Skill Set Requirement Proficient in reimbursement methodologies, hospital information systems and coding methodologies.
• Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms.
• Ability to analyze complex medical records and identify billable services. Strong quantitative, analytical, and organizational skills.
• Understanding of medical records, professional/hospital claims, and the Charge master.
• Ability to utilize and understand computer technology. Ability to understand ancillary department functions.
• Possesses a comprehensive knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes.
• Possesses a working knowledge of the UB-04/837 claim form loop and segments.
• Understands charging, coding processes along with compliance issues.

Job Types: Full-time, Temporary Pay: $24.00 - $25.00 per hour Experience:

• Physicians Based Coding : 5 years (Required)
• Pro Fee: 5 years (Required)
• PB Hospital Coding: 5 years (Required)

License/Certification:

• Certified Professional Coder (Required)

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