Senior Coding Denials Analyst

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Compensation:

Salary Range: $26.00 - $41.50

Union Position:

No

Department Details

Summary

Research and analyze coding related claim edits, denials, internal edits, Patient Financial Services (PFS) questions and concerns, as well as coding compliance software audit messages, to optimize reimbursement for Sanford.

Job Description

Ability to call Payers to help identify the issue on a particular denial, being able to articulate well for final resolution. Identify, edit, and error related trends as well as coding denial trends.

Responsible to accurately abstract diagnoses and treatments from documentation to support appropriate International Statistical Classification of Diseases (ICD)-10 and Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) coding.

Provides information on findings and trends to enterprise coding denial leadership as requested for use in coder education and other communications. Requests the development of coding edits to provide real-time opportunities for coders to receive front-end alerts during the coding process, aiding in revenue cycle enhancements.

Provides feedback and direction on coding related software edits, denial issues, reimbursement trends and billing/coding errors to Coding Denial Leadership.

Working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment or management of medical or surgical conditions required. Current knowledge in coding schemes, prospective payment systems, clinical practices, and technology. Knowledge with Remark and Reason codes sent from payers as well as reading a remittance advice. Demonstrates computer skills and knowledge of information systems.

Ability to effectively train others to achieve maximum accuracy. Must have knowledge of state and federal laws, rules and regulations.

Qualifications

Associate degree in Health Information Technology or Certification in Coding required.

Extensive knowledge of diagnostic and procedural terminology, International Statistical Classification of Diseases (ICD)-10, Current Procedural Terminology (CPT)-4 and Healthcare Common Procedure Coding System (HCPCS) coding schemes usually acquired through the following programs or certification: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Coding Specialist (CCS), or Certified Coding Specialist Professional (CCS-P).

Prefer to have at least two years of experience in coding for professional charges, as well as at least two years experience with Medicare and other third party reimbursement.

Maintain certification in Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS-P), Certified Professional Coder (CPC), or CPC-H (Certified Professional Coder-Hospital Outpatient) by fulfilling continuing education requirements.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to talent@sanfordhealth.org.

The Sanford organization owns and manages multiple distinct brands, including Sanford Health, Marshfield Clinic, and Good Samaritan, as well as Lewis Drug, Sanford Health Equip, Solutions by Sanford, Great Shots, and Blue Rock Bar & Grill.

About Sanford Health

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization has 53,000 employees and serves over 2 million patients and nearly 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 56 hospitals, 288 clinic locations, 147 senior care communities, 4,000 physicians and advanced practice providers and nearly 1,500 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to 78 specialties. Learn more about Sanford Health’s commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News.

About Good Samaritan

Good Samaritan, one of the nation’s largest nonprofit providers of senior care and services, is committed to transforming the aging experience through innovation, compassion and personalized care. As part of Sanford Health, an integrated nonprofit health system headquartered in Sioux Falls, South Dakota, Good Samaritan serves 10,000 seniors and offers access to a full continuum of care, including 94 rehabilitation and skilled nursing centers, 56 assisted living and memory care facilities, 44 independent living locations and 37 home health and hospice agencies. The senior care provider delivers services across the upper Midwest, with 70% of residents living in rural communities. Learn more about Good Samaritan’s mission and commitment to delivering high quality senior care in rural America at good-sam.com.