Job description

Responsible for working and appealing denied medical claims as related to coding and authorization issues as well as responding to medical records requests in terms of claims processing. Assisting offices and other billing staff with coding related issues. Initial coding of surgery and other charges as needed. Review the unresolved encounter report and surgery case logs to identify any missing charges Follow-up on missing chart documentation. Read OP notes and work with physicians to determine correct code and optimal reimbursement. Employee must be a TN resident and live within 120 miles of Knoxville, TN.

ESSENTIAL FUNCTIONS:

• Maintain current certification and knowledge of ICD-10 and CPT codes as well as CCI and MCO reimbursement policies.
• Process appeals for denied claims. Review EOB (Explanation of Benefits) and account to determine why the claim was denied. Prepare any correspondence and appeal the denial to the insurance company as appropriate. Correct any information necessary in the Practice management system so that proper charges are reflected and on the appeal.
• Follow-up on open encounters and missing chart documentation.
• Provide information to the insurance companies in a timely manner upon receipt of a request for medical records related to a pre or post claim review.
• Read OP notes and determine correct codes (CPT, ICD-10) based on documentation for optimal reimbursement.
• Work with Cash Posters and Patient Account Reps to identify issues that need close follow up.
• Work with physicians, site managers, office staff and CBO office staff to determine correct codes.
• Review hospital systems for most up to date patient and procedure information.
• Enter surgery charges as needed. Flag claims that need to be sent via paper or need additional attention by the Insurance Biller.
• Maintain coding skills by attending appropriate training classes, reviewing Medicare bulletins, journals, etc.
• Assist the biller as needed in filing paper claims for unlisted and Modifier 22 claims with proper documentation.
• Maintain and keep current all tasks assigned.
• Update patient demographics,as necessary.
• Maintains strict confidentiality of PHI (Protected Health Information) following Premier HIPAA (Health Insurance Portability and Accountability Act) policy and government regulation. Maintains strict confidentiality of employee information.
• Any other duties assigned by the Billing Director or COO.

The jobholder must demonstrate current competencies and experience applicable to the job position.

EDUCATION: High School diploma or GED.

EXPERIENCE: Minimum of five years' experience with medical coding, surgical practice experience is a plus.

REQUIREMENTS: CPC preferred. Will consider non-certified professional with excellent work experience.

Job Type: Full-time

Pay: $16.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Education:

• High school or equivalent (Required)

License/Certification:

• Certified Professional Coder (Preferred)

Work Location: Remote

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