Sr. Executive/ Executive HIM (Ancillary, Radiology, Denials)

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Minimum 2 years of Medical Coding Experience.
• Proficient knowledge of medical terminology with excellent Coding skills.
• Strong Knowledge on coding appropriate ICD’s, CPT’s and HCPC Codes.
• Knowledge of picking right Modifiers while coding the encounter related to Ancillary.
• Familiar with coding right diagnosis related to Ancillary coding.
• Maintaining a quality threshold of 97% and meeting the client’s expectations.
• Maintaining 100% production from day 1 (per ramp)
• Familiar with reading the operative report and arriving at appropriate CPT(s) and Diagnosis(es)

Key Responsibilities:

• Utilize ICD-10, CPT, and HCPCS coding systems to ensure accurate coding and billing practices.
• Collaborate with healthcare providers to clarify documentation and ensure compliance with coding guidelines and regulations.
• Maintain up-to-date knowledge of coding standards, regulations, and payer requirements to ensure accurate billing and reimbursement.
• Assist in the resolution of coding discrepancies and denials by providing necessary documentation and support.
• Participate in coding audits and quality assurance processes to ensure coding accuracy and compliance.
• Provide training and support to staff on coding practices and documentation requirements.
• Stay informed about changes in healthcare laws, regulations, and coding practices that may impact billing and reimbursement.

Ancillary & Radiology Coding:

• Review medical records and documentation for Ancillary (e.g., lab, physical therapy) and Radiology services.
• Assign accurate diagnosis and procedure codes using ICD-10-CM, CPT, and HCPCS.
• Ensure coding compliance with federal regulations and payer-specific guidelines.
• Collaborate with clinical staff to clarify documentation and ensure coding accuracy.
• Denials Management:
• Analyze and resolve coding-related denials and rejections.
• Prepare and submit appeals with supporting documentation.
• Identify denial trends and recommend process improvements.
• Work with billing and revenue cycle teams to reduce future denials

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.