Coding Denials Specialist
6 days ago
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:
- Performs retrospective (post–discharge/post-service) medical record quality audits to determine appellate potential of claims with denied reimbursement related to Inpatient and Outpatient coding data.
- 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, ICD-10 and CPT coding).
- Demonstrates ability to critically think, problem solve and make independent decisions supporting the coding appellate process.
- 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.
- 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: Conifer's system ACE, Invision, Star, Meditech, EPIC, MedAssets (formerly IMaCs), eCARE, Authorization log, InterQual, VI, HPF, as well as competency in Microsoft Office.
- Demonstrates basic patient accounting knowledge, i.e., UB04and EOB components, adjustments, credits, debits, balance due, patient liability, etc.
- Serves as a resource to non-coding personnel by responding to clinical team questions/consults if needed.
- 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.
- Follow client's operational and compliance policies and procedures, as applicable and as such policies and procedures.
- Perform as a team player.
- 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.
Education/ Experience:
- Graduate of any Medical Allied Health Courses
- Must have 3-4 yrs of IP coding experience
- Must have active CPC license
- Must be willing to work on a temporary work from set up
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