Job Summary:

The Coding and Charge Edits Specialist II will review and resolve all coding-related prebilling edits and rejections to ensure prompt and accurate reimbursement. This position initiates medical record reviews and recommends proper action. This job 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 l policies and procedures to ensure consistency of charge capture processes and reimbursements.

Job Responsibilities:

• Review and resolve all assigned tasks/encounters with coding discrepancies as related to pre-billing system edits and claims with outstanding balances.
• Reduce 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. Elevate coding problems to leadership.
• Analyze requests & execute charge correction.
• 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 to settle accounts. Act as a point of escalation and monitor supervisory or secondary work queues.
• Responsible for performing edits on high-dollar accounts.
• Assist Coding & Charge Edits Specialist with questions and concerns about coding and edits.
• Perform related duties as assigned within the scope of practice.

Job Qualifications:

• High School Diploma or GED required.
• At least 1 year’s experience in a physician billing or third-party payer environment. Candidates must demonstrate a 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.
• The candidate must demonstrate strong customer service and patient-focused orientation.
• Must demonstrate effective communication skills both verbally and written.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel Outlook, E-mail, etc.)
• Patient financial and practice management system experience in Epic or other electronic billing systems is preferred.
• Knowledge of medical terminology is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $23.56 - $31.25

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.