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Coding Escalation Specialist- Pro Fee Hospital
VENTRA Health
- New York, New York, United States
- New York, New York, United States
Über
Review and resolve escalated coding issues from coders, auditors, billing teams, and providers. Analyze medical records and documentation to ensure accurate and compliant code assignment Serve as a subject matter expert (SME) in coding guidelines and payer-specific rules. Identify coding trends, discrepancies, and compliance risks; recommend corrective actions. Participate in coding audits and assist in implementing audit recommendations. Educate and mentor coding staff on complex cases and updates to coding regulations. Ensure adherence to all applicable coding standards (CMS, AHA Coding Clinic, AMA CPT Assistant). Support continuous improvement initiatives in coding accuracy, workflow, and documentation quality. Maintain up-to-date knowledge of coding updates, regulatory changes, and payer guidelines.
Education and Experience Requirements
Minimum 3-5 years of experience in medical coding, with emphasis on complex case review or coding quality assurance. AAPC or AHIMA certification required.
Knowledge, Skills, and Abilities
Expert-level knowledge of ICD-10-CM, CPT, and HCPCS coding systems. Strong understanding of CMS regulations and payer-specific guidelines. Excellent analytical, problem-solving, and decision-making skills. Effective communication and interpersonal skills. Ability to work independently and manage multiple priorities in a fast-paced environment. Experience with electronic health records (EHRs) and coding software systems. Ability to read, understand, and apply state/federal laws, regulations, and policies. Ability to communicate with diverse personalities in a tactful, mature, and professional manner. Ability to remain flexible and work within a collaborative and fast paced environment. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic touch 10 key skills. Basic Math skills. Understand and comply with company policies and procedures. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
Compensation
Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies.
Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
Sprachkenntnisse
- English
Hinweis für Nutzer
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