Coding & Payment Compliance Specialist
St. Joseph's/Candler, Savannah, GA, United States
This position is responsible for ensuring coding and payment accuracy for outpatient hospital services performed at St. Joseph’s/Candler Health System. The Coding & Payment Compliance Specialist must be able to assign HCPCS, CPT codes and modifiers to outpatient encounters including emergency department visits, clinic visits, oncology treatment visits, recurring outpatient therapy and infusion center visits, diagnostic exams and testing, and laboratory reference accounts. The Coding & Payment Compliance Specialist serves as a liaison to clinical departments, Health Information Services (HIM), Physician Revenue Cycle and Pt Financial Services (PFS) to resolve claim edits and line item denials. The position is responsible for reviewing and resolving charge line item denials and identifying opportunities to prevent avoidable denials. Attention to detail is required for accurate capture of data elements, knowledge of coding and billing regulatory guidelines, and billing rules, commitment to ethical and compliant coding practices.
Education
Associate's degree in Health Information Administration or similar Healthcare related degree - Preferred
Experience
3-5 Years coding, healthcare billing, claims processing, denials management, payment processing or comparable experience - Required
Proficiency in using and creating data using Excel spreadsheets, preparing and presenting materials, reports or data using PowerPoint, Excel and other similar tools; attention to detail - Required
Working knowledge of Centers of Medicare and Medicaid (CMS) billing regulations - Required
License & Certificateion
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 - Required
Core Job Functions
Accurately review and resolve charge line denials to ensure proper billing and coding of outpatient hospital services for the health system.
Collaborate with clinical departments, PFS, HIM, and other revenue cycle departments to ensure appropriate rebilling of claims for denials, when appropriate.
Identify and collaborate with others to develop workflow and process improvements to prevent claim denials and incorrect payments.
Utilize Meditech, 3M and Trisus reference tools, resolve all national correct coding and outpatient code claim edits; and append appropriate modifiers to CPT and HCPCS codes.
Ensure documentation is reviewed and supports billing of services, modifiers, etc. for claims.
Review and resolve Meditech tasks assigned to Revenue Integrity including claim-line denials, quantity denials, and other billing or charge-related claim line issues.
Identify trends and provide recommendations to Senior RI Analyst and/or Director on process implementations to prevent denials.
Conduct post billing audits to identify revenue capture opportunities and potential payment compliance risks.
In conjunction with the Director, prepare a formal report of annual payment compliance work plan.
Provide assistance to other Revenue Integrity coworkers on daily and weekly essential functions when needed, including assistance with charge entry, pre and post bill audits, claim edits, MT account checks and other duties as assigned.
Follow the standards of professionalism set forth by AHIMA and AAPC. Ethically and accurately assign CPT/HCPCS procedure codes and modifiers in accordance with the CPT guidelines and Trisus Reference guidance.
Maintain certification and engage in continuing education activities. Stay up-to-date on regulations including national and local policies. Share knowledge with the rest of the team.
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Education
Associate's degree in Health Information Administration or similar Healthcare related degree - Preferred
Experience
3-5 Years coding, healthcare billing, claims processing, denials management, payment processing or comparable experience - Required
Proficiency in using and creating data using Excel spreadsheets, preparing and presenting materials, reports or data using PowerPoint, Excel and other similar tools; attention to detail - Required
Working knowledge of Centers of Medicare and Medicaid (CMS) billing regulations - Required
License & Certificateion
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 - Required
Core Job Functions
Accurately review and resolve charge line denials to ensure proper billing and coding of outpatient hospital services for the health system.
Collaborate with clinical departments, PFS, HIM, and other revenue cycle departments to ensure appropriate rebilling of claims for denials, when appropriate.
Identify and collaborate with others to develop workflow and process improvements to prevent claim denials and incorrect payments.
Utilize Meditech, 3M and Trisus reference tools, resolve all national correct coding and outpatient code claim edits; and append appropriate modifiers to CPT and HCPCS codes.
Ensure documentation is reviewed and supports billing of services, modifiers, etc. for claims.
Review and resolve Meditech tasks assigned to Revenue Integrity including claim-line denials, quantity denials, and other billing or charge-related claim line issues.
Identify trends and provide recommendations to Senior RI Analyst and/or Director on process implementations to prevent denials.
Conduct post billing audits to identify revenue capture opportunities and potential payment compliance risks.
In conjunction with the Director, prepare a formal report of annual payment compliance work plan.
Provide assistance to other Revenue Integrity coworkers on daily and weekly essential functions when needed, including assistance with charge entry, pre and post bill audits, claim edits, MT account checks and other duties as assigned.
Follow the standards of professionalism set forth by AHIMA and AAPC. Ethically and accurately assign CPT/HCPCS procedure codes and modifiers in accordance with the CPT guidelines and Trisus Reference guidance.
Maintain certification and engage in continuing education activities. Stay up-to-date on regulations including national and local policies. Share knowledge with the rest of the team.
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