Revenue Cycle Coder Denial Specialist
<div> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span xml:lang="EN-US" data-contrast="auto">At Proliance Surgeons our patients come from all walks of life — and so do we. We hire and support people from diverse backgrounds, fostering growth and development to make Proliance a great place to work. Our unique experiences and perspectives help us deliver </span><span xml:lang="EN-US" data-contrast="auto"><strong>Exceptional Outcomes, Personally Delivered</strong>.</span></span></p> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span xml:lang="EN-US" data-contrast="auto">We are proud to offer a comprehensive and competitive benefit and pay package including health coverage, 401k with match and profit share, PTO and more! For further details regarding Benefits and Washington State Minimum Wage details please visit our careers page at </span><span xml:lang="EN-US" data-contrast="none"><span data-ccp-charstyle="Hyperlink"><a rel="noopener" href="https://www.proliancesurgeons.com/careers" target="_blank">www.proliancesurgeons.com/careers</a></span></span></span><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span xml:lang="EN-US" data-contrast="auto">. <span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span xml:lang="EN-US" data-contrast="auto">Compensation during the offer process will be determined based on factors such as compensation structure, experience, qualifications, and internal equity. </span> </span><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;" xml:lang="EN-US" data-contrast="auto">Be Part of Who We Are!</span></span></span></p> </div><p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Position Summary</span></u></strong></p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">We are seeking a detail-oriented and analytical Revenue Cycle Coding Denial Specialist (Remote) to join our team. This role plays a key part in identifying denial trends, supporting Accounts Receivable (AR) workflows, and driving resolution through research, coding review, and appeal preparation.</p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><br>The ideal candidate brings strong coding expertise, sharp critical thinking skills, and a solid understanding of the full-billing and reimbursement lifecycle. This position also serves as a coding float, providing flexible support and coverage across coding teams as needed. <strong>Must have an a</strong><strong>ctive CPC certification with credentialing from AHIMA and/or AAPC.</strong></p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Schedule</span></u></strong></p> <p style="margin: 6pt 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Full-time, Monday - Friday.</p> <p style="margin: 6pt 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">**Must live in one of the following states or be willing to relocate to: WA, ID, FL, NC, AZ, OH, OR, TN, TX, or RI.** </p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Key Duties and Responsibilities</span></u></strong></p> <p style="margin: 6pt 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">The key duties and responsibilities of the Revenue Cycle Coder include, but are not limited to:</p> <ul style="margin-bottom: 0in; margin-top: 0px;"> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Review and analyze denied claims to determine root cause and appropriate resolution </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Identify denial trends and collaborate with coding, billing, and AR teams to improve outcomes </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Prepare and submit detailed, compliant appeal letters with supporting documentation </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Perform coding reviews to ensure accuracy and alignment with payer guidelines, CPT, ICD-10-CM, and HCPCS standards </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Partner with AR team members to resolve complex accounts and reduce aging receivables </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Communicate with providers and staff to obtain necessary documentation or clarification </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Assist with education and feedback to coding and billing staff based on denial findings </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Maintain up-to-date knowledge of payer policies, regulatory requirements, and coding updates </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Provide coding support across specialties as needed in a float capacity </li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Participate in process improvement initiatives to enhance revenue cycle performance.</li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Demonstrates appropriate utilization of coding software and coding reference material.</li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Follow up with providers on any documentation that is insufficient, missing, or unclear.</li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Assists providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding documentation and identifies opportunities for education and communicates trends to leaders.</li> <li style="margin: 0in 0in 0in 0px; text-align: justify; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Keeps up to date on carrier policies/guidelines to ensure all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or Payer-specific guidelines.</li> </ul> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong> </strong></p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Education/Experience</span></u></strong></p> <ul style="margin-bottom: 0in; margin-top: 0px;"> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Minimum 3 years of coding/medical billing experience</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif; font-weight: bold;"><strong>Active CPC certification with credentialing from AHIMA and/or AAPC, must be maintained annually --- required</strong></li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">ICD10 certified and/or extensive work experience</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Strong understanding of medical terminology, anatomy, and physiology </li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Experience with denial management, AR workflows, and appeals </li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Orthopedic coding experience strongly preferred </li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Experience with NextGen and SIS systems preferred </li> </ul> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Knowledge, Skills and Abilities</span></u></strong></p> <ul style="margin-bottom: 0in; margin-top: 0px;"> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">A strong understanding of physiology, medical terms, and anatomy</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Thorough attention to detail</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Excellent written and verbal communication skills</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Self-motivated team player able to multi-task and prioritize</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Excellent organization and interpersonal communication skills</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Strong computer skills</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Strong computer skills/experience with Microsoft Excel, Outlook, and Adobe</li> <li style="margin: 0in 0in 0in 0px; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">Working experience navigating EHR’s to abstract documentation</li> </ul> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><span style="color: #2ca5d5;"> </span></strong></p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"><strong><u><span style="color: #2ca5d5;">Work Environment/Physical Demands</span></u></strong></p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;">The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.</p> <p style="margin: 0in; line-height: normal; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="text-align: justify; margin: 0in 0in 8pt; line-height: 107%; font-size: 11pt; font-family: Calibri, sans-serif;">Work may be performed in a remote office and clinical environment. Requires corrected vision and hearing to normal range. While performing the duties of this job, the associate is regularly required to talk or hear. The associate is required to sit for long periods of time, stand and walk, bend and stretch. Use of telephone and computer is required. Manual dexterity required for use of computer keyboard. Occasionally lifts and carries items weighing up to 40 pounds. May requires working under stressful conditions or working irregular hours.</p>