Sanford Health Sioux Falls , SD 57101
Job Title: Senior Coding Denials Analyst Provider Practice | Health Information | Multi-City
Department : CLIN CODING DENIALS
Job Schedule: Full Time
Hours Per Shift: 8 hr
Research and analyze coding related claim edits, denials, internal edits, Patient Financial Services (PFS) questions and concerns, as well as coding compliance software audit messages to optimize reimbursement for Sanford. Ability to call Payers to help identify the issue on a particular denial, being able to articulate well for final resolution.
Identify edit and error related trends as well as coding denial trends. Responsible to accurately abstract diagnoses and treatments from documentation to support appropriate ICD-10 and CPT/HCPCS coding. Provides information on findings and trends to enterprise coding denial leadership as requested for use in coder education and other communications.
Requests the development of coding edits to provide real-time opportunities for coders to receive front-end alerts during the coding process, aiding in revenue cycle enhancements. Provides feedback and direction on coding related software edits, denial issues, reimbursement trends and billing/coding errors to Coding Denial Leadership. Working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment or management of medical or surgical conditions required.
Must have current knowledge in coding schemes and prospective payment systems and clinical practices and technology. Must have knowledge with Remark and Reason codes sent from payers as well as reading a remittance advice. Demonstrates computer skills and knowledge of information systems.
Analyzes the newest medical coding industry standards and assesses possible impacts on the organization. Uses a variety of computer hardware, operating systems, utilities and applications.
Processes large quantities of detailed information with high levels of accuracy. Communicates effectively with diverse audiences, using appropriate media and language. Follows organization's coding procedures and standards to conduct medical coding practices. Establishes and maintains effective working relationship with each team member.
This full time position will work daytime hours that are somewhat flexible after training (6-9mo) 5:00am-11:00pm option, with core 4 hours during 8:00am-5:00pm.
Must maintain certification in RHIA, RHIT, CCS, CCS-P, CPC or CPC-H by fulfilling continuing education requirements. Must have extensive knowledge of diagnostic and procedural terminology, ICD-10, CPT-4 and HCPC coding schemes usually acquired through the following programs or certification:
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Coding Specialist (CCS), or Certified Coding Specialist Professional (CCS-P). Prefer to have at least two years of experience in coding for professional charges, as well as at least two years experience with Medicare and other third party reimbursement. Working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment or management of medical or surgical conditions required.
Must have current knowledge in coding schemes and prospective payment systems and clinical practices and technology.
Demonstrates computer skills and knowledge of information systems. Must be able to effectively train others to achieve maximum accuracy. Must have knowledge of state and federal laws, rules and regulations.
About Sanford Health:
At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth.
We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition here in your community,
across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities.
We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application,
please call 1-877-673-0854 or send an email to firstname.lastname@example.org .
In compliance with federal law requiring employers to verify new employees' U.S.
employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .
Job Function: Revenue Cycle
Job Schedule: Full Time
Req Number: req24514