Strategic Staffing Solutions
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!
Strategic Staffing Solutions is currently looking for Professional Coding/Denials Specialists for a contract opportunity with one of our largest clients located in Detroit, MI / REMOTE!
Title: Professional Coding/Denials Specialist
Location: Detroit, MI / Remote
Duration: 12+ Months (Full-Time 40 hours typical working hours)
Role Type: W2 Contract Engagement
Rate: $20-$25/hr.
POSITION PURPOSE
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.
ESSENTIAL FUNCTIONS
- Knows, understands, incorporates, and demonstrates The Organization’s 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 Organization’s 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.
MINIMUM QUALIFICATIONS
- High school diploma or Associate degree in Accounting or Business Administration or related field, and a minimum of four (4) years’ experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred.
- Must possess comprehensive 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 The Organization’s.
The S3 Difference
The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities. The four pillars of our company are to:
- Set the bar high for what a company should do
- Create jobs
- Offer people an opportunity to succeed and change their station in life
- Improve the communities where we live and work through volunteering and charitable giving
As an S3 employee, you’re eligible for a full benefits package that may include:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Plan
- Vacation Package
- Life & Disability Insurance Plans
- Flexible Spending Accounts
- Tuition Reimbursement
To apply: Please email your resume in Word Format to Bob Cromer at: bcromer@strategicstaff.com and Reference Job Order # 216694.
Job ID: JOB-216694
Publish Date: 15 Aug 2023