Advocate Health
health system
PBCodingIntegritySpecialistPrimaryCareSpecialties
“PB Coding Integrity Specialist - Primary Care Specialties at Advocate Health. Skills: coding integrity, denial analysis, revenue cycle management, payer guidelines, coding standards. Analyze and resolve coding-related PB and HB denials using CPT, HCPCS, ICD-10-CM, and modifiers. Identify root causes, patterns, and trends in denial and rejection codes”
What You'll Achieve.
Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements; Support compliance, quality assurance, and revenue integrity initiatives
Industry & Context.
Advanced ability to identify coding discrepancies and provide recommendations for improvement; Effective critical thinking, creativity, problem solving and decision-making skills
Position requires travel which will result in exposure to road and weather hazards, Operates the equipment necessary to perform the job, Exposed to a normal office environment, Ability to pick start time after training, Hours will need to be between 5am to 7pm
What They're Looking For.
Must Have
Associate degree or equivalent education and experience required, Coding credential required, A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant experience, 4 years of experience in expert-level professional coding or hospital-based coding, Experience in revenue cycle processes, Experience in health information workflows, Medical record auditing experience, Advanced knowledge of third-party reimbursement programs, Advanced knowledge of state and federal regulatory issues, Advanced knowledge of national and local coverage decisions, Advanced knowledge of research related restrictions, Advanced knowledge of ICD-10-PCS/CM, CPT, and HCPCS coding classification systems, Advanced knowledge of medical terminology, anatomy, and physiology, Advanced ability to identify coding discrepancies and provide recommendations for improvement, Advanced ability to analyze trends and data and display them in a statistical reporting format, Advanced knowledge of care delivery documentation systems and related medical record documents, Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines, Advanced knowledge of Microsoft Office, Advanced knowledge of video and web conferencing, Advanced knowledge of email, Experience with electronic coding and EHR systems or applications, Advanced interpersonal and communication (oral and written) skills, Ability to effectively collaborate with multiple departments, Advanced organization and prioritization ability to manage multiple priorities in a stressful, fast-paced work environment, Advanced analytical skills, with great attention to detail, Self-motivated with initiative and sense of ethics, Ability to work independently and exercise independent judgment and decision making, Ability to meet deadlines while working in a fast-paced environment, Organizational skills and ability to work independently with limited guidance or direction, Effective critical thinking, creativity, problem solving and decision-making skills
Nice to Have
Second Specialty credential preferred
What You'll Do.
Analyze and resolve coding-related PB and HB denials using CPT
and trends in denial and rejection codes
Collaborate with billing
and payer teams to correct
and prevent denied claims
Conduct chart reviews to validate documentation against billed services
Prepare and support appeals by researching payer guidelines
and coverage policies
compliant coding and sequencing aligned with official guidelines and payer requirements
and report denial resolutions
and coding quality issues
and revenue integrity initiatives through issue monitoring and escalation resolution
and staff by sharing findings and supporting targeted training based on denial trends
Contribute to operational and strategic initiatives
including denial avoidance strategies
work queue optimization
and technology-driven improvements
How You'll Work.
Team & Collaboration
Collaborate with billing, coding, and payer teams; Effectively collaborate with multiple departments
Communication Scope
Advanced interpersonal and communication (oral and written) skills
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