· Knows, understands, incorporates, and demonstrates the Client 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.
· Other duties as needed and assigned by the Supervisor Clinical / Coding Payment Resolution.
· Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Client Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Requirements
· High school diploma or Associate degree in Accounting or Business Administration or related field, and a minimum of four (4) years' degree preferred
· knowledge of professional/physician diagnostic and procedural coding, as normally obtained through a coding certificate program
· and least one (1) year of physician/professional or hospital outpatient coding experience or minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.
· Must be a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or coding credential of a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).
· Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
· Possesses detailed understanding of principles, methods, and techniques related to compliant healthcare billing/collections.
· Possesses expertise in medical terminology, disease processes, patient health record content and the medical record coding process.
· Must be comfortable operating in a collaborative, shared leadership environment.
· Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Client
As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability.