Inspire health. Serve with compassion. Be the difference.Job Summary Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. All team members are expected to be knowledgeable of payer guidelines related to coding and appeal timelines. Communicates with providers regarding coding denial issues. Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc.Essential FunctionsAll team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.Responsible for working coding claim denials accurately and timely in accordance with performance and productivity goals.Utilizes appropriate coding software and coding resources in order to determine correct codes.Communicates billing related issuesFollows departmental policies for charge corrections.Participates in coding educational opportunities (webinars, in house training, etc.).Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns.Submits appeals for assigned payer and/or division.Assists with Compliance Team and Coding Educators to identify areas that require additional trainingParticipates in meetings in order to improve overall billingPerforms other duties as assigned.Supervisory/Management ResponsibilitiesThis is a non-management job that will report to a supervisor, manager, director or executive.Minimum RequirementsEducation - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferredExperience - Two (2) years professional coding and/or billing experienceIn Lieu OfNARequired Certifications, Registrations, LicensesCertified Professional Coder-CPCKnowledge, Skills and AbilitiesMaintains knowledge of governmental and commercial payer guidelines.Knowledge of office equipment (fax/copier)Proficient computer skills including word processing, spreadsheets, databaseData entry skillsMathematical skillsWork Shift Day (United States of America)Location Independence PointeFacility 7001 CorporateDepartment 70019178 Medical Group Coding & Education ServicesShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
