Integrity Specialist - HB Coding Denials

American Addiction Centers • Milwaukee, WI

95d • $28 - $42

About The Position

The position is for a Coding Specialist within the Enterprise Revenue Cycle - Coding & HIM Support department. This is a full-time role with a remote opportunity, requiring 40 hours per week on the first shift. The role involves reviewing coded health information records to ensure the quality of coding and abstracting, verifying the accuracy of assigned diagnostic and procedure codes, and ensuring compliance with coding guidelines. The Coding Specialist will work collaboratively with coding leadership to identify records for review, provide education opportunities, and participate in coding denial and appeal processes.

Requirements

• Coding Specialist (CCS) certification or equivalent registration from AHIMA.
• Associate's Degree in Health Information Management or related field.
• Typically requires 5 years of experience in hospital coding for a large complex health care system.
• Demonstrated leadership skills and abilities.
• Expert knowledge in ICD-10-CM/PCS and CPT coding systems.
• Advanced knowledge in Microsoft Applications including Excel, Word, PowerPoint, Teams.
• Advanced understanding of anatomy, physiology, medical terminology, and pharmacology.
• Excellent communication and reading comprehension skills.
• Demonstrated analytical aptitude with high attention to detail.

Responsibilities

• Review coded health information records to evaluate the quality of staff coding and abstracting.
• Ensure accurate coding for outpatient, day surgery, and inpatient records.
• Verify all codes and sequencing for claims according to AHA coding guidelines.
• Collaborate with coding leadership to review records with focused diagnosis and procedure codes.
• Identify coder education opportunities and team trends.
• Review encounters flagged for second level review.
• Perform review of coded encounters for appropriate risk-adjustment.
• Participate in the Clinical Documentation Improvement and Hospital Coding alignment process.
• Review accounts with mismatched DRG assignment.
• Recommend educational topics for coders and clinical documentation nurses.
• Ensure timely review and response to third-party payer notifications.
• Investigate and resolve edits or inquiries from the billing office.
• Clarify changes in coding guidance or educational materials.
• Maintain continuing education credits and credentials.

Benefits

• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match.
• Educational Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 11-50 employees