Coding Denial Specialist
Location
Worldwide
Posted
74 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Coding Denial Specialist
PBS Radiology Business Experts
Job DetailsLevel: ExperiencedPosition Type: Full TimeEducation Level: High School Graduate or EquivelantTravel Percentage: No TravelJob Shift: DayJob Category: Health CareAre you interested in working with an authentic team who care about their clients and employees? PBS is committed to excellence in revenue cycle, practice improvement, and service to physician practices. We are looking for experienced, talented individuals who value integrity, innovation and teamwork. Position Summary: The Coding Denial Specialist is responsible for investigating and resolving coding-related denials by submitting corrected claims or making appropriate corrections through payer portals. In this role, you will take ownership of resolving insurance claim denials for assigned accounts in a timely manner. The position requires strong analytical skills, independent judgment, and a thorough understanding of diagnostic and interventional radiology billing practices. Additionally, the Coding Denial Specialist must maintain current knowledge of healthcare billing laws, regulations, industry developments, and coding and billing guidelines. Duties and Responsibilities: Analyze coding-related denials to identify root causes and implement appropriate corrective actions. Review accounts to apply necessary adjustments, respond to inquiries, and update coding or account information as needed. Manage a high volume of denials while maintaining quality standards and compliance with healthcare billing laws and regulations. Resolve denials efficiently with the objective of minimizing charges aged over 120 days. Prepare clear, well-supported written appeals in accordance with payer-specific guidelines. Communicate denial trends and payer policy updates to leadership and team members. Monitor recurring denial patterns and recommend solutions to prevent future occurrences. Maintain current knowledge of payer requirements, including managed care, commercial, governmental, and Medicare documentation, coding, and billing guidelines. QualificationsRequired Education and Experience 1. High school diploma or GED diploma 2. Previous job-related experience and/or training, or equivalent combination of education and experience 3. Minimum 2 years of professional billing, claim denials, appeals, and revenue cycle work. 4. Must have thorough working knowledge of CPT, ICD-10, HCPCS, modifiers and medical terminology. 5. Must have thorough working knowledge of Medicare, Medicaid, and Commercial payers coding/billing guidelines and compliance regulations, including medical policy restrictions (LCDs and NCDs) 6. Complete understanding of follow-up processes 7. Exceptional written and verbal communication skills 8. Strong analytical, organizational, and research skills, with extreme attention to detail 9. Proficient using multiple software applications for Microsoft Office 10. Ability to prioritize assignments to meet deadlines. 11. Ability to work independently in a remote setting, as well as part of a team. 12. Self-starter with the ability to work under limited oversight in a remote setting. Preferred Education and Experience 1. Coding certification through AAPC, AHIMA or RCCB; preferred 2. Minimum 2 years of coding in a professional outpatient setting; preferred 3. Imagine software experience; preferred.
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