Job Details

Join to apply for the Claims Resolution Coder - Remote role at Sentara Health

Overview

Claims Resolution Coder Remote. Responsible for reviewing medical documentation to assign modifiers to insurance claims with issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), or other third party payer specific claims processing guidelines. Works with Coding, Billing and Reimbursement staff to resolve edits. Responsible for trending errors, supporting identification of root causes, and effective communication with coding and training staff to improve coding accuracy and clean claims processing. Researches regulations to ensure accuracy of CPT codes and documentation.

Details

City/State: Norfolk, VA

Work Shift: First (Days)

Responsibilities

• Review medical documentation to assign modifiers to insurance claims with issues identified by NCCI, OCE, or other payer guidelines.
• Collaborate with Coding, Billing and Reimbursement staff to resolve edits.
• Trend errors and support identification of root causes; communicate findings to coding and training staff to improve coding accuracy and clean claims processing.
• Research regulations to ensure accuracy of CPT codes and documentation.

Education & Experience

• Associate degree in Health Information Technology or Medical Billing preferred.
• 2 years direct application of coding, medical billing or reimbursement in a health care setting (hospital or physician office) required.

Certification/Licensure

• CPC or CCS Certification (Required) at time of hire.
• Thorough knowledge of lab, radiology and other ancillary CPT, HCPCS related modifiers and revenue codes; knowledge of Medicare NOD and LCD guidelines.

Experience (continued)

• Demonstrates working knowledge of medical record documentation requirements and ability to interpret documentation.

Education Minimum

• High School diploma or equivalent
• Associate degree preferred

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance $5,250/year and discounted educational opportunities
• Student Debt Pay Down $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Potential eligibility for annual discretionary bonus based on established criteria

Equal Opportunity

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce. Diversity, inclusion, and belonging guide the organization to reflect the communities it serves. This is a tobacco-free environment in support of our mission to improve health every day.

Remote work states: Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.