Claims and Denial Coding Analyst

St. Luke’s University Health Network•Allentown, PA

About The Position

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Claim and Denial Coding Analyst role is a Certified Medical Coder who 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.

Requirements

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.
Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications.
The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator.
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.
Performs searches of governmental, payor-specific, 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, workshops, 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.