Claims Denial Specialist Job at Your Health, Columbia, SC

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  • Your Health
  • Columbia, SC

Job Description

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Claims Denial Specialist

Columbia SC

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About

We are a leading physician group serving South Carolina and Georgia, dedicated to delivering quality healthcare directly to patients in care facilities, homes, clinics, and virtual visits. Our services include comprehensive primary care, specialty services, and pharmacy support, tailored to meet diverse patient needs. Committed to excellence and innovation, our team collaborates closely with facilities and families to ensure accessible, coordinated, and compassionate care.

Why Choose a Career at Your Health?

Providing high quality care for our patients is the center of what we do, and we provide the same care for our employees. Here are some of the benefits that are available to our employees.

  • Competitive Compensation Package with Bonus Opportunities
  • Employer Matched 401K
  • Free Visit & Prescriptive Services with HDHP Insurance Plan
  • Employer Matched HSA
  • Generous PTO Package
  • Career Development & Growth Opportunities
  • Company Vehicle

What Are We Looking For?

Your Health is currently looking for a Billing Specialist join our growing urgent care family. A specialist who has worked denied insurance claims and reports

Qualifications

Responsibilities:

  • Review patient medical records to accurately abstract and assign diagnostic codes (ICD-10-CM) and procedural codes (CPT, HCPCS) based on physician documentation.
  • Ensure coding accuracy and compliance with coding conventions, official coding guidelines, and regulatory requirements such as HIPAA and CMS regulations.
  • Query physicians or other healthcare providers for clarification or additional documentation when necessary to accurately assign codes.
  • Analyze medical records and clinical documentation to identify discrepancies or potential coding issues and take appropriate corrective actions.
  • Adhere to coding productivity and accuracy standards set by the organization or industry benchmarks.
  • Stay updated on changes and updates to coding guidelines, regulations, and reimbursement methodologies.
  • Collaborate with other members of the healthcare team, including physicians, nurses, and healthcare administrators, to ensure accurate coding and billing practices.
  • Assist with coding-related audits, compliance reviews, and quality improvement initiatives.
  • Maintain confidentiality of patient health information and ensure compliance with privacy and security regulations.
  • Provide coding expertise and support to billing and revenue cycle management staff as needed.
  • Participate in ongoing professional development activities to enhance coding knowledge and skills.

Qualifications:

  • High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
  • Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar coding credential from a recognized professional organization (e.g., AAPC, AHIMA).
  • Proficiency in medical terminology, anatomy, physiology, and disease processes.
  • Strong understanding of coding guidelines and regulations, including ICD-10-CM, CPT, and HCPCS Level II coding systems.
  • Excellent attention to detail and accuracy in coding assignments.
  • Ability to interpret and analyze complex medical documentation.
  • Strong communication and interpersonal skills, with the ability to effectively communicate with physicians and other healthcare professionals.
  • Proficiency in using coding software and electronic health record (EHR) systems.
  • Ability to work independently and efficiently in a fast-paced environment.
  • Familiarity with insurance reimbursement processes and billing requirements is a plus.

Experience: Previous experience in medical coding or healthcare documentation is preferred, but entry-level positions may be available for candidates with relevant education and certification

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Job Tags

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