St. Joseph's/Candler · 4 days ago
Coding & Payment Compliance Specialist
Savannah, GA
Full-time
Onsite
Mid Level
3+ years expSt. Joseph's/Candler is a health system seeking a Coding & Payment Compliance Specialist responsible for ensuring coding and payment accuracy for outpatient hospital services. The role involves assigning codes, resolving claim edits, and collaborating with various departments to improve billing processes.
BiotechnologyFitnessHealth Care
Responsibilities
Accurately reviews and resolves charge line denials to ensure proper billing and coding of outpatient hospital services for the health system. Collaborates with clinical departments, PFS, HIM and other revenue cycle departments to ensure appropriate rebilling of claims for denials, when appropriate. Identifies and collaborates with others to develop workflow and process improvements to prevent claim denials and incorrect payments
Utilizing the tools including Meditech, 3M and Trisus reference, resolves all national correct coding and outpatient code claim edits; and appends appropriate modifiers to CPT and HCPCS codes. Ensures documentation is reviewed and supports billing of services, modifiers, etc. for claims
Reviews and resolves Meditech tasks assigned to Revenue Integrity including claim-line denials, quantity denials and other billing or charge related claim line issues. Identifies trends and provides recommendations to Senior RI Analyst and or Director on process implements to prevent denials
Conducts post billing audits to identify revenue capture opportunities and potential payment compliance risks. In conjunction with the Director, prepares formal report of annual payment compliance work plan
Provides assistance to other Revenue Integrity coworkers on daily and weekly essential functions when needed. This includes, but not limited to, assistance with charge entry, pre and post bill audits, claim edits, MT account checks and other duties as assigned
Follows the standards of professionalism set forth by AHIMA and AAPC. Ethically and accurately assigns CPT/HCPCS procedure codes and modifiers in accordance with the CPT guidelines and Trisus Reference guidance. Maintains certification and engages in continuing education activities. Stays up-to-date on regulations including national and local policies. Shares knowledge with the rest of the team
Qualification
Required
3-5 Years Coding, Healthcare Billing, Claims Processing, Denials Management, Payment Processing or comparable experience
Proficiency in using and creating of data using Excel spreadsheets, preparing and presenting materials, reports or data using PowerPoint, Excel and other similar tools; attention to detail
Working knowledge of Centers of Medicare and Medicaid (CMS) billing regulations
Certification by American Health Information Management Association (AHIMA) CCA, RHIT, RHIA, CCS; or certification by the American Academy of Professional Coders (AAPC) CPC or COC or comparable medical coding certification
Preferred
Associate's degree in Health Information Administration or similar Healthcare related degree
1-2 Years Outpatient Coding
Company
St. Joseph's/Candler
St.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Allen Butcher
Chief Financial Officer
Kyle McCann, MBA, FACHE
Chief Operating Officer
Recent News
Savannah Morning News
2024-02-12
Savannah Morning News
2024-02-12
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