Deskripsi Pekerjaan
Join Sales Rain BPO Inc. as an Outpatient Coding Appeals Specialist and become a vital advocate for healthcare reimbursement accuracy. In this pivotal role, you'll develop compelling clinical and coding justifications for denied claims, ensuring healthcare providers receive rightful reimbursement. You'll analyze complex medical documentation, interpret coding guidelines, and collaborate with clinical teams to resolve discrepancies. This position requires meticulous attention to detail, deep knowledge of outpatient coding standards, and the ability to articulate complex coding concepts clearly. Perfect for professionals passionate about healthcare compliance and revenue cycle management, this opportunity offers growth in a dynamic BPO environment while making tangible impacts on healthcare operations.
Tanggung Jawab
- Develop and submit coding-based appeals with clear clinical documentation justifications
- Analyze medical records to identify coding discrepancies and appeal opportunities
- Collaborate with healthcare providers to clarify documentation and coding accuracy
- Stay updated on current coding guidelines (ICD-10, CPT) and regulatory requirements
- Track appeal status and maintain detailed documentation of all processes
- Communicate effectively with insurance companies and internal stakeholders
- Identify trends in denials to recommend process improvements
Kualifikasi
- Certified Professional Coder (CPC) or equivalent certification required
- Minimum 2 years experience in outpatient medical coding
- Proficiency in ICD-10, CPT, and HCPCS coding systems
- Familiarity with healthcare regulations including HIPAA and CMS guidelines
- Strong analytical skills with attention to detail
- Excellent written and verbal communication skills
- Ability to work independently and in team environments
- Associate degree in Health Information Management preferred