Claims Solution Coders utilize their professional coding expertise and knowledge of the professional revenue cycle to perform coding abstraction, reviews, and final validation of complex professional claims. They resolve issues requiring coding expertise, mentor Claims Solution Specialists, and collaborate with clinic leadership, providers, and billing colleagues to enhance the efficiency and accuracy of the professional claims process. Our Claims Solution Specialist – Coders leverage their professional coding expertise and understanding of the professional revenue cycle to perform coding abstraction and reviews, and final validation and resolution of complex professional claims issues requiring coding expertise. They provide mentorship to Claims Solution Specialists, and engage clinic leadership, providers, and other billing colleagues to participate in the continuous improvement efforts focused on increasing the efficiency and accuracy of the professional claims process. Essential Functions: Resolve Advanced Claims Issues: Utilize certified coding expertise to address and resolve complex claims issues. Mentor and Support: Guide and assist Claims Solution Specialists in their daily duties, providing mentorship and support. Design Support Tools: Develop tools and resources to aid Claims Solution Specialists in their responsibilities. Provide Training and Helpline Support: Conduct training sessions and answer questions through the coding helpline. Design Standing Orders: Create standing orders to enable the management of claims by individuals without coding experience or certification. Skills: Medical Insurance Coding, Medical Billing and Coding, Claims Processing, Claims Management, Claims Resolution, Insurance Industry, Computer Coding, Healthcare, Billing, Medical Billing. Minimum Qualifications: CPC coding certification. Professional coding experience or medical billing experience. Preferred Qualifications: Advanced coding knowledge (e.g., CCI edits, appeal management), Root cause analysis experience. Physical Requirements: Interact with others requiring the employee to communicate information. Operate computers and other office equipment requiring the ability to move fingers and hands. See and read computer monitors and documents. Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
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