Integrity Specialist – Complex Specialties

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🏈 Alabama, Alaska, +31 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $33 - $49 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Advocate Aurora Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $10.2M Grant on 2019-08

Healthcare • Healthcare Insurance

Advocate Aurora Health is a leading healthcare organization that operates across various regions including Central Chicagoland, Central Wisconsin, Greater Milwaukee, and more. With a diverse range of career areas such as advanced practice clinicians, behavioral health, nursing, and more, Advocate Aurora Health is committed to helping people live well. The organization offers numerous benefits and opportunities for career advancement, fostering an environment where individuals can thrive and innovate in the healthcare sector. Advocate Aurora Health prioritizes the safety of its candidates and maintains a robust recruitment process to protect sensitive information.

📋 Description

• Analyze and resolve coding-related PB denials using CPT, HCPCS, ICD-10-CM, and modifiers • Identify root causes, patterns, and trends in denial and rejection codes • Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims • Conduct chart reviews to validate documentation against billed services • Prepare and support appeals by researching payer guidelines, coding standards, and coverage policies • Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements • Track, document, and report denial resolutions, appeal outcomes, and coding quality issues • Support compliance, quality assurance, and revenue integrity initiatives through issue monitoring and escalation resolution • Educate clinicians, coders, and staff by sharing findings and supporting targeted training based on denial trends • Contribute to denial avoidance strategies, work queue optimization, CARC code mapping, and technology-driven improvements

🎯 Requirements

• Associate degree or equivalent education and experience required • Coding credential required • Coding Certification from AHIMA or AAPC with relevant experience • 4 years of experience in expert-level professional coding or hospital-based coding • Experience in revenue cycle processes, health information workflows, and medical record auditing • Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research-related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems • Advanced knowledge of medical terminology, anatomy, and physiology • Ability to identify coding discrepancies and provide recommendations for improvement • Ability to analyze trends and data and display them in a statistical reporting format • Advanced knowledge of care delivery documentation systems and medical record documents • Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines • Advanced knowledge of Microsoft Office, video and web conferencing, email, electronic coding, and EHR systems or applications • Advanced interpersonal and communication skills • Advanced organization and prioritization skills • Advanced analytical skills and attention to detail • Ability to work independently, exercise independent judgment, and make decisions • Ability to meet deadlines in a fast-paced environment • Critical thinking, creativity, problem-solving, and decision-making skills • Ability to travel, with exposure to road and weather hazards • Second specialty credential preferred

🏖️ Benefits

• Benefits Eligible • Competitive compensation • Premium pay such as shift, on call, and more based on a teammate's job • Incentive pay for select positions • Opportunity for annual increases based on performance • Paid Time Off programs • Medical, dental, vision, life, and Short- and Long-Term Disability benefits • Flexible Spending Accounts for eligible health care and dependent care expenses • Adoption assistance • Paid parental leave • Defined contribution retirement plans with employer match • Financial wellness programs • Educational Assistance Program • Career development programs • Well-being programs