Apply on Employer Site

Healthrise · 1 month ago

Coding Denials Resolution Specialist / Coding Team Lead

United States

Full-time

Remote

Mid, Senior Level

4+ years exp

Healthrise is a company focused on healthcare revenue operations, and they are seeking a Coding Denials Resolution Specialist / Coding Team Lead. The role involves reviewing post-billed denials for coding accuracy, appealing them based on expertise, and leading a team in coding best practices.

Financial Services

Comp. & Benefits

Responsibilities

Knows, understands, incorporates, and demonstrates the Healthrise Core Values

Provides detailed understanding or aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims

Responsible for understanding and resolving Professional Billing HCFA1500 claims or other coding-related issues, and processing charge corrections based on medical record reviews, contracts, and regulations as directed by the supervisor

Interprets data, draws conclusions, and reviews findings with all levels for further review

Takes initiative to continuously learn all aspects of the role to support progressive responsibility

Maintains a working knowledge of applicable federal, state, and local laws and regulations

Serves as first-line support for coders, answering questions, troubleshooting issues, and escalating complex cases to the manager

Reviews team members’ work for accuracy and compliance, providing coaching and real-time feedback

Tracks productivity and quality metrics at the individual and team level and communicates performance trends to leadership

Supports onboarding and training of new coders, ensuring consistency in process knowledge and documentation

Responsible for monitoring and maintaining assigned leader workqueues

Qualification

ICD-10-CM codingCPT-4 codingProfessional Billing HCFA1500Coding certification RHIACoding certification RHITCoding certification CCSCoding certification CPCHealthcare billing principlesMedical terminologyTeam leadershipCommunication skillsProblem-solving skills

Required

High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four years of experience in a hospital, clinic environment, health insurance company, managed care organization, or healthcare financial service setting; or an equivalent combination of education and experience

Comprehensive knowledge of professional/physician diagnostic and procedural coding, typically obtained through a coding certificate program, and at least one year of professional and hospital outpatient coding experience, or a minimum of two years of hospital inpatient coding experience including DRG assignment

Must hold one of the following credentials: RHIA, RHIT, CCS, CPC. CPMA will also be considered

Experience with NCCI edits, NCDs, LCDs, and outpatient coding guidelines for official coding and reporting

Detailed understanding of compliant healthcare billing and collections principles

Expertise in medical terminology, disease processes, patient health record content, and the medical record coding process

Comfortable operating in a collaborative, shared leadership environment

Remote work environment requiring a dedicated space that ensures confidentiality and privacy

Frequent communication via Microsoft Teams, email, and phone with colleagues across locations

Manual dexterity required to operate a keyboard; hearing required for phone and Teams communication

Ability to concentrate, meet deadlines, work on multiple projects, and adapt to interruptions

Must be able to set and manage work priorities independently, adjust to changing demands, and work under potentially stressful conditions with individuals possessing diverse personalities and work styles, including Global Partner vendors