Ambulatory Coder, Denials
Prisma Health
full-time
Posted on:
Location Type: Remote
Location: South Carolina • United States
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About the role
- Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims.
- Communicates with providers regarding coding denial issues.
- Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc.
- Serves as a subject matter expert for assigned specialty.
- Utilizes appropriate coding software and coding resources in order to determine correct codes.
- Communicates billing related issues to assigned supervisor/manager.
- Follows departmental policies for charge corrections.
- Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns.
- Submits appeals for assigned payer and/or division.
Requirements
- Five (5) years professional coding and/or billing experience
- Certified Professional Coder - CPC CPMA or Specialty Coding Certification for assigned specialty
- Maintains knowledge of governmental and commercial payer guidelines.
- Knowledge of office equipment (fax/copier)
- Proficient computer skills including word processing, spreadsheets, database
- Data entry skills
- Mathematical skills
Benefits
- Inspire health.
- Serve with compassion.
- Be the difference.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
codingbillingCPT codesModifiersHCPCS codesICD-10 codesdata entrymathematical skills
Soft Skills
communicationfeedbackproblem-solving
Certifications
Certified Professional Coder - CPCCPMASpecialty Coding Certification