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Job Details

Coding Claim Edit Specialist/ CCS (Remote)

Requisition #: 498608
Location: Johns Hopkins Health System, Baltimore, MD 21201
Category: Coding
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: No
Date Posted: March 11, 2022

Join an amazing global healthcare organization!

Excellent compensation package!

Awesome benefits, including dependent tuition reimbursement!

REMOTE-Must be located in MD, VA, DC, FL, PA, DE or willing to relocate!

Requisition #:396163


Shift:Location:

Full Time (40 hours)

8:30am - 5:00pm

Weekends Not Required

Non Exempt, NH

Position Summary:

The Analyst Outpatient Coding Denials & DNFB (Discharged Not Final Billed), under the coordination of the Lead Analyst Outpatient Coding Denial and DNFB, is responsible for the daily review and management of the Outpatient Coding denials and DNFB for all facilities within the Johns Hopkins Health System. The Analyst Outpatient Coding Denials & DNFB will review and resolve Outpatient claim edits by monitoring aging accounts and prioritizing, providing resolution, and identifying barriers preventing Outpatient claims from being billed and reimbursed timely. The Analyst Outpatient Coding Denials & DNFB will investigate all Outpatient accounts that are not final coded, prioritizing by established criteria, such as oldest discharge date, or highest dollar value, and resolve issues preventing final coding. The Analyst will work with all key stakeholders to resolve issues impacting coding delays to support DNFB goals.

Education/Certification/Experience:

Track 1: High school diploma w/ CCS required. Experience equivalent to (3) three years of coding Outpatient hospital records.
Track 2: Associates Degree/RHIT required. CCS Preferred. Experience equivalent to (3) three years of coding Outpatient hospital records.
Track 3: Bachelor Degree/RHIA required. CCS Preferred. Experience equivalent to (2) two years of coding Outpatient hospital records.
Required Recruitment Screening: Successful completion of AHIMA approved coding skills assessment: Coder II

Knowledge, Skills and Abilities:

  • Knowledge of revenue cycle processes and the relationship of coding to billing timelines.
  • Knowledge of Outpatient coding quality programs and payer models, including but not limited to:
    • CMS’s Outpatient Prospective Payment System and APC reimbursement,
    • Maryland’s HSCRC outpatient reimbursement,
    • all applicable OCE edits which includes NCCI and NCD/LCD edits and the accuracy of coded data impacting reimbursement and external quality databases.
  • Knowledge AHA and CMS rules and regulations for code assignment and denials management.
  • Detailed knowledge of medical coding systems, procedures, documentation requirements and regulatory requirements, Medical Terminology, Clinical Anatomy and Physiological. Knowledge of legal, regulatory, and policy compliance issues related to medical coding diagnoses, procedures and documentation.
  • Knowledge of current and developing issues and trends in medical coding diagnosis and procedures requirements.
  • Working knowledge of Chargemaster processes, and charge strategies beneficial.
  • Ability to code using the latest ICD-10CM and CPT/HCPCS coding classification systems.
  • Ability to prioritize work and provide prompt efficient service. Ability to analyze and solve problems.
  • Excellent oral and written communication skills.
  • Ability to adapt and modify medical coding processes, protocols, and work within data management systems to meet specific operating requirements.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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