Senior Coding Denials Analyst

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Compensation:

Salary Range: $26.00 - $41.50

Union Position:

No

Department Details

Summary

Research and analyze coding related claim edits, denials, internal edits, Patient Financial Services (PFS) questions and concerns, as well as coding compliance software audit messages, to optimize reimbursement for Sanford.

Job Description

Ability to call Payers to help identify the issue on a particular denial, being able to articulate well for final resolution. Identify, edit, and error related trends as well as coding denial trends. Responsible to accurately abstract diagnoses and treatments from documentation to support appropriate International Statistical Classification of Diseases (ICD)-10 and Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) coding. Provides information on findings and trends to enterprise coding denial leadership as requested for use in coder education and other communications. Requests the development of coding edits to provide real-time opportunities for coders to receive front-end alerts during the coding process, aiding in revenue cycle enhancements. Provides feedback and direction on coding related software edits, denial issues, reimbursement trends and billing/coding errors to Coding Denial Leadership. Working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment or management of medical or surgical conditions required. Current knowledge in coding schemes, prospective payment systems, clinical practices, and technology. Knowledge with Remark and Reason codes sent from payers as well as reading a remittance advice. Demonstrates computer skills and knowledge of information systems. Ability to effectively train others to achieve maximum accuracy. Must have knowledge of state and federal laws, rules and regulations.

Qualifications

Associate degree in Health Information Technology or Certification in Coding required.

Extensive knowledge of diagnostic and procedural terminology, International Statistical Classification of Diseases (ICD)-10, Current Procedural Terminology (CPT)-4 and Healthcare Common Procedure Coding System (HCPCS) coding schemes usually acquired through the following programs or certification: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Coding Specialist (CCS), or Certified Coding Specialist Professional (CCS-P). Prefer to have at least two years of experience in coding for professional charges, as well as at least two years experience with Medicare and other third party reimbursement.

Maintain certification in Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS-P), Certified Professional Coder (CPC), or CPC-H (Certified Professional Coder-Hospital Outpatient) by fulfilling continuing education requirements.

Sanford is an EEO/AA Employer M/F/Disability/Vet. 

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