Full Job Description
Work from home/Remote from any location within Indiana or Illinois
High School Diploma/ GED Required. Bachelors's Preferred
WHAT WE NEED
Accurate coding extraordinaire
WHO WE ARE LOOKING FOR
High quality health care is both a calling and a business. And the business side identifies trends and looks for ways to reduce denials. Bottom line: this job is important for back-end operations.
Are you accurate and detail-oriented? Do you have experience working in health care? We’ve got a place where your skills are needed and ultimately help provide the best health care to our patients.
WHAT YOU WILL DO
Review, research, and respond to customer service, denial management, and follow-up questions according to Coding Department approved resources.
Review and process claims and edits for accuracy and insurance and coding compliance.
Utilize official coding guidelines and follow established policies and procedures to determine accurate code selection based upon documentation in the medical record.
Act as a subject matter expert for coding, billing and payer edits and denials.
Assess and rank denials priority to align with Rev Cycle goals.
Assess denial and take action to adjust claim data and resubmit corrected claim, prepare and coordinate appeal response, and prepare avoidable write off documentation.
Collaborate with coding leadership to improve key performance indicators through trending denials.
Coordinate timely response to denials, reaching out to other Franciscan Alliance departments as well as payers when necessary through denial resolution.
Recommend improvements/adjustments to workflow and system build in response to changes in reimbursement methodology, coding guidelines, regulatory standards or department workflow changes to prevent denials.
WHAT IT TAKES TO SUCCEED
Prior Coding experience.
Prior experience in Coding Denials/Payer.
Knowledge of types of health information and the rules and regulations surrounding their use.
Advanced understanding of ICD10CM coding, ICD10PCS coding, CPT coding, and coding guidelines.
Advanced understanding of coding grouping methodologies.
Understanding of payer relationships, requirements and compliant billing practices and role of the Healthcare provider related to insurance processes.
Knowledge of Managed Care requirements under the Medicare/Medicaid and other third party payor programs.
Understanding of common medical terminology, anatomy and physiology and terminology used in diagnosis and classification of illnesses, injuries, and disabilities.
Knowledge of pharmaceutical terminology, generic and trade names, and ICD coding.
Understanding of anatomy and physiologic concepts as they relate to relevant diagnostic testing and course of treatment.
Critically evaluate and analyze information in written materials.
Solve problems by analyzing information and using logic to address issues and problems.
Proficient in Microsoft Office Applications.
Effectively communicate verbally and in writing as appropriate for the needs of the audience.
WHAT WE'RE LOOKING FOR
3+ years experience, preferably coding multiple speciality areas for physician office services. Experience with payer policies and LCD (Local Coverage Determinations) preferred
Certification(s):Minimum of Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required, Registered Health Information Technology (RHIT) or Registered Health Information Administration (RHIA) preferred
Travel: Never or Rarely
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
BILLING & HEALTH INFORMATION