Claims Review Analyst - Professional Coding Services - York - Full Time - Day

York, PA | Allied Health | Tracking Code: 58157

Position Summary:

General Summary:

Under general supervision of the Supervisors of Professional Coding Services, supports the System in charge capture, coding accuracy, and claim denials management. Conducts reviews of claim denials and submits appeals. Performs a variety of functions including, but not limited to, answering inquiries researching third party payor policies and coding guidelines to optimize reimbursement for the System while ensuring compliance with applicable laws and regulations.


Duties and Responsibilities:

1 Consults with departments throughout the System on charge process. Ensures appropriate use of CPT, HCPCS and ICD-10 codes as well as modifiers.
2 Conducts reviews comparing medical record documentation to validate charge capture, medical necessity and coding accuracy.
3 Investigates and recommends action steps and works collaboratively with the department when coding and/or compliance issues are found. Frequently communicates denial trends and billing errors.
4 Identifies denial trends and follows up on root cause to prevent further denials.
5 Investigates billing system errors, through help desk tickets and work queues, as a result of potentially inappropriate documentation, coding, medical necessity of charge entry. Communicates with departments to advise action steps for resolution. Communicates with Compliance when issues are identified.
6 Investigates payer denials and institutes appropriate course of action.
7 Prepares detailed appeals.
8 Interacts with physicians, managers and staff in departments to ensure correct coding of claims.
9 Maintains current knowledge of payor/insurance policies, rules and regulations, including state and federal guidelines.
10 Demonstrates initiative and resourcefulness by communicating results of claims review activity to PCS Supervisor, PFS Managers, Director, Patient Financial Services-PB.
11 Serves as departments Point Person when assigned and consistently displays good judgment, decision making and independence in the role, functioning with limited guidance and supervision.
12 Attends Insurance Update meetings, provides synopsis of bulletins and notifies affected areas.
13 Requests coding edits in EPIC based on payor bulletins and/or policies.
14 Assists the PCS Supervisors and PFS Managers in the completion of routine assignments and special projects as needed.

Required Skills

Associate’s Degree Required

Certified Procedural Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) Required

Required Experience

3 – 5 years Billing/Claims experience Required

Excellent communication and interpersonal skills; excellent oral presentation skills; experience with public speaking and basic computer skills; works effectively in a team environment.

Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Similar Opportunities