Coding Denials Specialist
Coding Denials Specialist
Posted on :
22-10-2024
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
22-10-2024
Job Description
JOB SUMMARY: Coding Denial Representative is responsible to review payor s denial and identify the root cause of the denials account. Coding Denial Representative determines if the account is appealable or not. Coding Denial Representative must understand and comply with the process established by the Federal and State regulations Payor s specific guidelines Official Coding Guidelines and able to navigate the system properly. The Coding Denial Representative must ensure the confidentiality and privacy of information. Essential Functions: 1. Performs retrospective (post discharge/postservice) medical record quality audits to determine appellate potential of claims with denied reimbursement related to Inpatient and Outpatient coding data. 2. Constructs and documents a succinct and fact based case to support the appeal utilizing appropriate resources and medical record document(s) to support the appeal. (Resources include AHA Official Coding and Reporting Guidelines CMS guidelines ICD10 and CPT coding). 3. Demonstrates ability to critically think problem solve and make independent decisions supporting the coding appellate process. 4. Demonstrates proficiency in ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC and CC) and procedures. Provides education/feedback and coding guidance to client regarding coding cases that did not warrant appeal resolution. 5. Demonstrates proficiency in utilization of electronic tools utilized during the medical record quality review process including but not limited to application of coding guidelines; patient accounting application; work listing application; visual imaging/scanning application; payor websites electronic medical record following Conifer s training of Assigned Personnel: Conifers system ACE Invision Star Meditech EPIC MedAssets (formerly IMaCs) eCARE Authorization log InterQual VI HPF as well as competency in Microsoft Office. 6. Demonstrates basic patient accounting knowledge i.e. UB04and EOB components adjustments credits debits balance due patient liability etc. 7. Serves as a resource to noncoding personnel by responding to clinical team questions/consults if needed. 8. Will write the appeal letter (and electronically transmit the letter) in the appropriate host system: ACE Invision Star Meditech EPIC MedAssets or others as may be applicable. 9. Follow client s operational and compliance policies and procedures as applicable and as such policies and procedures. 10. Perform as a team player. 11. Use logic critical thinking and reasoning to identify the strengths and weaknesses of alternative solutions to problems. 12. Understand the effects of new information for both current and future problemsolving and decisionmaking. 13. High attention to detail 14. Attendance in accordance with company HR and department policies 15. Other tasks/functions that may be assigned by the company as per business requirement; these may change from time to time to reflect the changing requirement of your position and our business.
Employment Type
Full Time
Key Skills
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