Claims and Denial Coding Analyst
St. Luke's University Health Network•Allentown, PA
About The Position
The Claim and Denial Coding Analyst is a Certified Medical Coder responsible for ensuring clean claim submission and the timely review and resolution of coding-related claim denials for professional services, FQHC, MSO, and ASCs across the network. This role involves utilizing provider documentation and queries, coding software tools, and insurance carrier medical and reimbursement policies during the claim review process.
Requirements
- 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 Haves
- Epic Resolute experience helpful
Responsibilities
- Maintain current knowledge of coding, compliance, 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
- Make claim corrections after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications
- Collaborate with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator during the appeals process
- Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance
- 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, spreadsheets, account, and claim examples of root cause issues
- Perform searches of governmental, payor-specific, guidelines to identify coding and billing requirements and 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
- Attend coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations
- Assist with training new staff in all aspects of the Analyst role
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
