Job Summary:

The Coding and Charge Edits Specialist III will be responsible for the review and resolution of all coding related prebilling edits and/or rejections to ensure prompt and accurate reimbursement. This position initiates medical record review and recommends proper action. This 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. Follows organizational policies and procedures to ensure consistency of charge capture processes and reimbursements.

Job Responsibilities:

• 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.
• Reduces accounts receivable by reviewing claims with outstanding balances.
• Assess clinical documentation supporting services.
• Research and respond to insurance coding requests.
• Assist with claim issues, including preparing coding appeals.
• Proactively elevates coding problems to leadership.
• Analyze charge correction requests that are submitted.
• Execute charge corrections in order to ensure to achieve account resolution.
• Assist in developing policies and procedures related to Charge Corrections.
• Generate reports to monitor the types of errors and their frequency.
• Research accounts and request any needed supporting documentation.
• Review and analyze denials and reach out to payers in attempt to settle accounts.
• Responsible for performing edits on high dollar accounts.
• Act as a point of escalation and monitor supervisory or secondary work queues
• Scope of responsibility may include utilizing reports to monitor volumes and overall success rates.
• Assist more junior staff with coding and edits.
• Assist supervisor/manager with monitoring edit requests.
• Assists with training support of new hires
• Perform other duties as assigned.

Job Qualifications:

• High school graduate or GED certificate is required.
• CPC certification is required via the AAPC or AHIMA
• A minimum of 2 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.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Patient financial and practice management system experience in Epic and or other of electronic billing systems is preferred.
• Knowledge of medical terminology is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $27.88 - $37.61

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

61st Street Service Corporation

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.