St. Luke's
Healthcare
ClaimsandDenialCodingAnalyst
“Claims and Denial Coding Analyst at St. Luke's. Skills: Coding, Claim denial resolution, Provider documentation review. Ensures clean claim submission and timely review and resolution of coding related claim denials for professional services, FQHC, MSO, and ASCs across the network. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process”
What You'll Achieve.
Ensures clean claim submission; Timely review and resolution of coding related claim denials
Industry & Context.
Resolve coding denials through claim correction or appeal; Formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance; Identify and coding and billing requirements to make recommendations
Sitting for up to 8 hours per day, 3 hours at a time, Standing and walking as necessary, Fingering and handling frequently, twisting and turning of hands occasionally, Pushing and pulling, Occasionally stoops, bends, squats, kneels and reach above shoulder level, Hearing as it relates to normal conversation, Seeing as it relates to general and near vision
What They're Looking For.
Must Have
Professional Fee Radiology Coding and Billing Experience required, CPC or CCA certification required, At least 2 years of active E&M and/or Surgical Coding experience required, Must possess a comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding, Knowledge and experience in dealing with third party insurance companies relative to claim processing and coding denials follow up
Nice to Have
Epic Resolute experience helpful
What You'll Do.
Ensures clean claim submission and timely review and resolution of coding related claim denials for professional services
and ASCs across the network
Utilizes provider documentation and queries
coding software tools and Insurance carrier medical and reimbursement policies during the claim review process
Maintain current knowledge of coding
and documentation guidelines
Resolve Charge Review and Claim Edit CCI/LCD edits
diagnosis coding errors and MUE frequency for clean claim submission
Resolve coding denials through claim correction or appeal
Provide coding guidance to providers and charge entry staff for single or low volume errors
Report high volume coding denial trends to the coordinator
Maintain meticulous documentation
and claim examples of root cause issues
Performs searches of governmental
guidelines to identify and coding and billing requirements to make recommendations
Review TCM Charge Review encounters to verify the documentation supports all required TCM components
Relevel TCM service when not supported by the documentation or TCM has been rendered during another TCM 30-day period
Attends coding conferences
and in house sessions to receive updated coding information and changes in coding and/or regulations
Assists with training new staff in all aspects of the Analyst role
How You'll Work.
Team & Collaboration
Collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator during appeals process; Provide coding guidance to providers and charge entry staff; Report high volume coding denial trends to the coordinator; Assists with training new staff
Communication Scope
Provide coding guidance to providers and charge entry staff; Formulate an appeal rationale
Applying for this Claims and Denial Coding Analyst role?
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