CAAD Specialty Denial Representative I

Overview

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training​

Premium pay such as shift, on call, and more based on a teammate's job​

Incentive pay for select positions​

Opportunity for annual increases based on performance​

Paid Time Off programs​

Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability​

Flexible Spending Accounts for eligible health care and dependent care expenses​

Family benefits such as adoption assistance and paid parental leave​

Defined contribution retirement plans with employer match and other financial wellness programs​

Educational Assistance Program​

Job Summary

Performs assignment of ICD and CPT codes in cases of low to intermediate complexity.

Essential Functions
 

• Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered.
• Appends limited modifiers, e.g., -24, -25, -59.
• Codes minor surgical procedures.
• Assigns Evaluation and Management (E/M) codes.
• Performs reconciliation process to ensure all charges are captured.
• Processes automated or manually enters charges into applicable billing system.
• Researches, answers, and processes all edits associated with claim and coding submission.
• Processes charges on a timely basis and communicates with team members to be sure department guidelines regarding timeliness are met.
• Communicates with providers related to coding issues that are of low to intermediate complexity.
• Assigns E/M codes from provider documentation.

Physical Requirements
 

Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending.

Education, Experience and Certifications
 

High School Diploma or GED required. CPC, CPC-A or equivalent coding credential required. Some coding, medical billing and/or clinical experience preferred. Maintains coding certification (CPC, CPC-A, CCS, RHIT, RHIA). Annually reviews new and revised CPT and ICD codes. Understanding of and familiarity with regulatory guidelines including NCDs and LCDs. Working knowledge of coding, medical terminology, anatomy, and physiology.

Preferred:  3-5 years of denial experience.