Coding & Reimbursement Specialist
About The Position
Join our Coding Abstractionist Team as a Coding & Reimbursement Specialist supporting critical follow-up denial and claim edit work queues. In this role, you’ll play a key part in reviewing and resolving denied charges by payors, ensuring coding accuracy and compliance across ICD-10 diagnoses, CPT code leveling, required modifiers, and units of service. You’ll collaborate closely with Compliance, Abstraction, and Accounts Receivable (A/R) teams to ensure all charges meet coding guidelines and payor-specific requirements—helping drive clean claims and faster reimbursement. This role is ideal for an experienced coder who enjoys problem-solving, working across teams, and making a direct impact on revenue cycle performance.
Requirements
- Proven, hands-on coding experience (required)
- Strong knowledge of denial management, abstraction, and A/R workflows
- Ability to navigate payor-specific coding requirements
- At least three (3) years of work experience in healthcare billing or collections environment or other related role. Required
- Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely Required
- Strong math aptitude (Required proficiency)
- Excellent organizational skills. (Required proficiency)
- Clear and concise decision making skills (Required proficiency)
- Leadership skills (Required proficiency)
- Detail oriented (Required proficiency)
- String interpersonal skills (Required proficiency)
- Excellent writing and oral communication skills (Required proficiency)
- Ability to work independently; results oriented (Required proficiency)
- Ability to handle confidential matters. (Required proficiency)
- Flexibility to work overtime as needed/required (Required proficiency)
Nice To Haves
- CCS, CCS-P, or CPC certification strongly preferred due to current business needs
- Certified Coding Specialist (CCS) - AAPC, AHIMA - upon hire - Preferred
- Certified Coding Specialist-Physician-Based (CCS-P) - AAPC, AHIMA - upon hire - Preferred
- Certified Professional Coder (CPC) - AAPC, AHIMA - upon hire - Preferred
- Certified Professional Coder Apprentice (CPC-A) - AAPC, AHIMA - upon hire - Preferred
- Bachelor's Degree Preferred
- Experience with Epic system (Preferred proficiency)
Responsibilities
- Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
- Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
- Monitors work queues assigned as their responsibility, meeting established production and quality standards for the assigned tasks.
- Specific focus is project oriented. Identify trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
- Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
- Stays current on regulations and industry standard trends to ensure CHOP is compliant.
- Responsible for creating presentation and data analytics to drive change and improvements.
- Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.
- Other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
