What are the responsibilities and job description for the Coding Specialist position at PathGroup?
JOB SUMMARY :
The Coding Specialist has knowledge of RCM denial management to resolve coding-related third party payor denials. Coding Specialists increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include documentation improvement and coding denials prevention.
JOB RESPONSIBILITIES
ESSENTIAL FUNCTIONS :
- Performs front-end review of client documentation to ensure the client has provided documentation that supports the requested services. Review requisitions to ensure the claim is billed accurately.
- Analyze invalid denial trends, payer-specific carrier submission requirements & system optimization.
- Performs retrospective coding and documentation review of denied charges. Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing and works with referring providers to obtain additional information as needed.
- Performs extensive follow-up to investigate and resolve payment denial trends.
- Ensures denial reviews are conducted on time.
- Participates in annual and ongoing mandatory employee training. Fulfills Continuing Education Units necessary to maintain certification status.
- Meets productivity standards, identify any issues or trends and bring them to the attention of management.
- Demonstrates excellent interpersonal, verbal and communication skills.
- Follows coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
- Demonstrates the ability to function independently, and use critical thinking and analytical skills.
- Performs all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
- Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including the Privacy and Security policies.
NON-ESSENTIAL FUNCTIONS :
EDUCATION & LICENSURE :
REQUIREMENTS :
