Coding Denials Specialist
1 week ago
Coding Denials 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. (Resourcesinclude AHA Official Coding and Reporting Guidelines, CMS guidelines, ICD-10 and CPTcoding).
- Demonstrates proficiency in ability to achieve accuracy and consistency in the selection of
- Demonstrates proficiency in utilization of electronic tools utilized during the medical record
- Demonstrates basic patient accounting knowledge, i.e., UB04and EOB components,
- Will write the appeal letter (and electronically transmit the letter) in the appropriate host
- Follow client's operational and compliance policies and procedures, as applicable and as
- Perform as a team player.
- Other tasks/functions that may be assigned by the company as per business requirement;
- Graduate of any Medical Allied Health Courses
- Must have 3-4 yrs of IP coding experience
- Certification is dependent on client requirement.
- o AAPC Coding Certification: CPC, COC, CICo AHIMA Coding Certification: CCA, CCS-P, CCS
- Must be willing to work on a temporary work from set up
Job Type: Full-time
Benefits:
- Paid training
Work Location: Remote
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