Medical Billing, Coding and Denial Specialist

📋 Description

• Accurately assign ICD-10-CM diagnosis codes for inpatient encounters.

• Accurately assign ICD-10-PCS procedure codes.

• Review physician documentation to ensure completeness and accuracy.

• Identify complications and comorbidities to guarantee proper DRG assignment.

• Query physicians for clarification of documentation when necessary.

• Ensure adherence to all relevant coding guidelines.

• Accurately assign CPT/HCPCS codes for outpatient services.

• Review encounter/charge data for completeness before claiming submission.

• Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims.

• Validate all coding assignments and charges against supporting documentation.

• Submit claims electronically via the designated clearinghouse or billing system.

• Monitor the acceptance or rejection status of claims.

• Review and analyze claim denials and rejections.

• Track denial trends and suggest process improvements.

• Maintain a 95% accuracy rate in patient billing.

• Document all coding decisions, queries, and corrections related to claims.

• Collaborate with clinical documentation improvement staff.

⛳️ Requirements

• A minimum of 10 years of experience in hospital medical billing and coding.

• At least 5 years of proven experience in a supervisory role within a hospital setting is highly desirable.

• Extensive background in Emergency Room (ER) medical billing and coding.

• Required system experience with one or more of the following: CareVue, VistA, CPRS.

• Familiarity with hospital billing systems and clearinghouses.

• Experience in electronic claims submission.

• Active certification as a CPC or CCS is preferred.

• Thorough knowledge of Medicare and Medicaid billing requirements.

• Proficiency in ICD-10-CM diagnosis and procedure coding.

• Proficiency in CPT/HCPCS coding.

• Experience with UB-04/837I institutional claim formats and CMS-1500/837P professional claim formats.

• Knowledge of APC assignment.

🏝️ Benefits

• Comprehensive and competitive benefits package.