The Coding and Charge Edits Specialist II will be responsible for the review and resolution of all coding related prebilling edits and/or rejections to ensure prompt and accurate reimbursement. This job role will also review and analyze all charge correction requests and then process any needed adjustments/edits. The individual is the point person within the department responsible for making all charge corrections.
Review and resolve all assigned tasks / encounters associated with coding discrepancies as it relates to pre-billing system edits and and/or claims with outstanding balances.
Assess clinical documentation supporting services. Research accounts and request any needed supporting documentation.
Research and respond to insurance coding requests. Assist with claim issues, including preparing coding appeals.
Analyze charge correction requests that are submitted.
Execute charge corrections in order to ensure to achieve account resolution. Resolve all correction requests accurately and in a timely approach.
Generate reports to monitor the types of errors and their frequency.
Review and analyze denials and reach out to payers in attempt to settle accounts.
Responsible for performing edits on high dollar accounts.
High school graduate or GED certificate is required.
A minimum of 1 years’ experience in a physician billing or third party payer environment.
Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.
Must successfully complete systems training requirements.