Ambulatory Coder Denials, FT, Days - Remote

Prisma Health Remote
ambulatory remote billing health procedures clinical documentation compliance education physician billing management training expert healthcare

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. All team members are expected to be knowledgeable of payer guidelines related to coding and appeal timelines.


  • Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.

  • Accurately abstract diagnosis, procedures, and evaluation and management codes for all applicable patient care settings.

  • Utilizes applicable software and coding resources to evaluate and optimize code assignment to accurately assign diagnoses, procedure, and HCPCS codes for documented professional services.

  • Effectively utilize EMR system to review and validate coding as submitted on professional claims as assigned.

  • Provides real-time feedback to surgical/procedural and clinical providers as it pertains to proper coding and clinical documentation of services performed.

  • Process pre-billing clinical edits within department timeframes.

  • Mentor and assists in training of other coders within the department.

  • Participate in the development of coding policies and procedures as identified.

  • Reports any improvement opportunities department leaders as appropriate to ensure compliance and revenue capture expectations are met.

  • Educate assigned physician and clinical staff regarding coding and documentation guidelines.

  • Assist with research and development of presentation materials for continuing education programs for physician in their areas of specialization.

  • Maintain expert knowledge of managed care carrier clinical documentation, coding, and billing guidelines.

  • Maintain expert knowledge of governmental payer clinical documentation, coding, and billing guidelines.

  • Abides by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders (AAPC), and/or American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

  • Abide by all Palmetto Health Physician Billing Coding and Compliance policies and procedures.

  • Complete annual CEU requirements as determined by governing body for coding certification designation.

  • Act as a coding resource for peers and other internal customers of the Physician Billing Department.

  • Performs any and all other duties as necessary to achieve goals and objectives of the Physician Billing –Coding and Compliance department.

Minimum Education

Associate’s degree in related field of study or equivalent training/certification required.

Minimum Experience

5 years of experience in an acute care setting required.

Licensure, Registry or Certification Required

Requires one of the following certifications; AAPC, CCS-P, RHIT, or RHIA.

Work Shift

Day (United States of America)


1200 Colonial Life Blvd


1001 Corporate Services - Upstate


10019178 Coding & Education

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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