Coding Compliance Specialist Remote USA
Remote
Revenue Cycle – Coding /
Full-Time /
Remote
The vision of Clinical Health Network for Transformation (CHN) is to better fulfill the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.
CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health and race equity in our organization.
Position Description
Reporting to the Revenue Cycle Manager, the Coding Compliance Specialist is responsible for using their skills as a certified coder to examine claim rejections and denials for action and remedies to include provider inquiries, claim edits or corrections, and following through the claims appeals process in accordance with all organizational policies and standards, as well as applicable regulatory requirements. The Coding Compliance Specialist will be resourceful and keep up to date with all code (CPT, HCPCS, ICD10, etc.) or policy changes and make recommendations to ensure claims are processed appropriately. The Coding Compliance Specialist is an essential source for relative coding and compliance training of CHN staff and collaborating with the CHN Liaisons to communicate and implement necessary action.
Essential Functions
- Determines appropriateness for appeals.
- Follows-up on all assigned accounts from within the billing systems with pre-established goals.
- Responds timely and accurately to all incoming coding review requests.
- Initiate proactive measures that result in account resolution.
- Demonstrates knowledge of policies, procedures/rules, and regulations used in interpreting proper billing and coding processes and techniques.
- Reviews annual CPT and ICD10 changes, payor notices, coverage policy changes, new payor coding and billing regulations. Reviews all regulatory compliance correspondence and adheres to all guidelines.
- Provide expertise and research claim inquiries through communication with affiliate sites and internal personnel. Coordinate documentation, tracking, and resolution of all billing and payment issues by completing forms, reports, logs, and records.
- Initiate appropriate recommendations and action plans for resolving coding denials and claim appeals. Research claims processing guidelines, payer contracts, fee schedules, and system configurations to determine root cause of payment error or denial.
- Participate in audits and review of claims and coding information. Track trends in claims processing issues and make recommendations to leadership to ensure claim processing aligns with contractual agreements and state regulations.
- Reviews insurance payments and denials and recommends billing corrections.
- Trains staff members on the coding process and provides physician education as necessary or requested.
- Identify charging or clinical documentation issues and work with appropriate leadership and Revenue Cycle Liaisons to resolve issues.
- Write appropriate notes in the billing system, including any action taken.
- Ensure compliance with HIPAA (Health Insurance Portability and Accountability) regulations and requirements.
- Understand the importance and relevance of assigned tasks in meeting overall departmental and organizational goals.
- Maintain credential(s) through continuing education opportunities.
- Understand the importance and relevance of assigned tasks in meeting overall departmental and organizational goals.
- Maintain credential(s) through continuing education opportunities.
- Creates and promotes a culture of continuous improvement.
- Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations.
- Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community.
- Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems.
- Provides positive and development feedback and accountability related to practices including, but not limited to, equity.
The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.
Qualifications and Experience (Required)
- High School Diploma, in a related field or equivalent experience
- A minimum of 7 years of experience as a medical coder in the health care field, with a successful record of accomplishment of contributing to acceptable days in accounts receivable measurements.
- Coding Certification through AHIMA (CCS -P) OR AAPC (CPC, CRC), OR equivalent certification
- Strong analytical and problem-solving abilities.
- Proficiency with Microsoft software (Excel, etc.).
- Demonstrated ability to maintain a customer-centric service approach in an evolving, iterative environment.
- Excellent written and verbal communication skills and ability to collaborate and interact with all levels within CHN.
- Strong attention to detail and follow-up; and ability to adapt and shift as needed.
- Demonstrated dedication to Planned Parenthood’s mission, vision, and values.
- Strong interpersonal skills and the ability to build relationships with stakeholders.
- Excellent time management.
Qualifications and Experience (Preferred)
- Associate degree in a related field
- Experience with EPIC
Key Requirements
- Commitment to advancing race(+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society.
- Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions.
- Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn.
- Strong sense of accountability to equitable practices.
- Understanding of the impact of identity dynamics on organizational culture
- Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards.
Total Rewards. CHN provides employees with a competitive compensation and benefits; some highlights include the following.
- Above Position Compensation Range: $50,252/year (Minimum); goes up based on relevant experience
- Geographic Differentials available for residences of NYC or Bay Area, CA
- Health Care Coverage (Medical, Dental, & Vision); eligibility for full-time, regular employees on date of hire
- Flexible Spending Accounts and Health Savings Account
- Short-Term Disability and Basic Life & AD&D Insurance provided by CHN
- Voluntary elections for Long Term Disability and Additional Life & AD&D Insurance available at cost
- Employee Assistance Program
- Retirment Plan, 3% employer match after one year of service
- Paid Time Off Program includes accrual-based PTO and nine (9) paid Holidays
Clinical Health Network for Transformation (CHN) is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including people of color and members of the LGBTQ community.
