About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

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As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards.

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Job Summary

We are seeking a detail-oriented and experienced Healthcare Coding Suspends Senior Specialist to join our team. The ideal candidate will have a strong background in medical coding and billing, with expertise in identifying and resolving coding-related suspends. The Medical Coding Suspends Specialist will be responsible for reviewing and resolving coding-related suspends to ensure accurate and timely claim submission and reimbursement.

Essential Functions and Tasks

• Review and analyze coding-related suspends generated by coding software or systems, identifying errors, discrepancies, and missing information.
• Conduct thorough reviews of medical records, encounter forms, and other relevant documentation to validate code assignments and ensure compliance with coding guidelines and regulations.
• Research and interpret coding guidelines, policies, and regulations, including CPT, ICD-10, HCPCS, and payer-specific coding requirements, to accurately assign and sequence diagnosis and procedure codes.
• Collaborate with coding and billing staff, clinicians, and other stakeholders to gather additional information, clarify documentation, and resolve coding-related issues.
• Correct code assignments, modifiers, and other coding elements as needed to address coding-related suspends and ensure accurate claim submission.
• Document coding-related activities, findings, and resolutions in coding software or systems, maintaining accurate and complete records of coding-related suspends and resolutions.
• Communicate coding-related trends, issues, and best practices to coding and billing staff, providing education, training, and support as needed to improve coding accuracy and compliance.
• Stay informed about changes and updates in coding guidelines, regulations, and payer policies, and implement necessary changes to ensure compliance and optimization.
• Assist with coding audits, reviews, and compliance initiatives, identifying coding errors, patterns, and opportunities for improvement.
• Participate in coding-related meetings, committees, and projects, contributing expertise and insights to support coding and billing operations.

Education and Experience Requirements

• Bachelor's degree in any Life Science field.
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or related coding certification required.
• Minimum of 2-3 years of experience in medical coding, with a focus on coding suspends and denials.

Knowledge, Skills, and Abilities

• In-depth knowledge of CPT, ICD-10, HCPCS, and other coding systems and guidelines.
• Familiarity with coding software and systems, such as encoders, grouper software, and Electronic Health Record (EHR) systems.
• Strong analytical and problem-solving skills, with the ability to identify and resolve coding-related issues effectively.
• Excellent attention to detail and accuracy, with a commitment to maintaining high coding standards and compliance.
• Effective communication and interpersonal skills, with the ability to collaborate with multidisciplinary teams and stakeholders.
• Proficiency in medical terminology, anatomy, physiology, and disease processes.
• Ability to work independently and prioritize tasks in a fast-paced healthcare environment.
• Willingness to stay updated on coding-related trends, regulations, and best practices through continuing education and professional development.

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.

Equal Employment Opportunity

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/.