Job Title: Coding Payment Resolution Specialist
Location; Columbus, Ohio
Start Date: ASAP
Duration: Full Time
- Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and coding judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and determining root causes of denials.
- Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. in addition to promoting departmental awareness of coding best practices. This position reports directly to the Supervisor Clinical/Coding Payment Resolution.
- Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
- Provides detailed understanding or aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, regulations as directed by the Supervisor Clinical / Coding Payment Resolution.
- Interprets data, draws conclusions, and reviews findings with all level of Payment Resolution Specialist for further review.
- Takes initiative to continuously learn all aspects of Payment Resolution Specialist role to support progressive responsibility.
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