What are the responsibilities and job description for the Claims Resolution Coder position at Sentara?
Claims Resolution Coder
Responsible for reviewing medical documentation to assign modifiers to insurance claims with issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE),or other third party payer specific claims processing guidelines. Works with Coding, Billing and Reimbursement staff to resolve edits. Is additionally responsible for trending errors, supporting identification of root causes, and effective communication with coding and training staff to improve coding accuracy and clean claims processing. Researches regulations to ensure accuracy of CPT codes and documentation.
Associates degree in Health Information Technology or Medical Billing preferred. 2 years direct application of coding, medical billing or reimbursement in health care setting, hospital or physician office required. CPC or CCS coding certification required at time of hire. Thorough knowledge of lab, radiology and other ancillary, CPT, HCPCS related modifier and revenue codes, as well as knowledge of Medicare NOD and LCD guidelines. Demonstrates working knowledge of medical record documentation requirements and ability to interpret documentation.
Education
- High School Diploma or equivalent (Required)
Certification/Licensure
- Certification - CCS Coding Cert through AHIMA or
- CPC Coding Cert through AAPC
Experience
- 2 years Coding experience Required
- 2 years Reimbursement/Revenue Cycle required
- 2 years Billing
- Opportunity for Remote
Salary : $1,000 - $1,000,000