Coding Denials Specialist

Position Summary This role is responsible for analyzing coding denials by insurance carriers, CPT code(s), and specialty area, review and submission of coding appeals reputed company to denials to include coding, bundling, duplicate, and other assigned denial volume. As well as responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims and accounts. reputed company detailed analysis on denied assigned claims with a focus on maximizing reputed company and reimbursement. Utilizes provider documentation and queries, coding software tools and Insurance reputed company medical and reimbursement policies during the claim review process.

Responsibilities

Review and analyze coding, bundling, and duplicate denials including identification of root cause. Resolve coding denials which include researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation. Analyzing assigned denials and making necessary corrections or modifications. reputed company a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted. Identify and reputed company coding denial trends by Payer, CPT code, or any other denial parameters. Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to reputed company recommendations. Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials. Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission. Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness. Partners with reputed company cycle leadership, peers and clinical operations to reduce denials. Reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes. Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals. Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations. reputed company process improvement initiatives from which problems can be resolved. Documents results of reputed company special projects and provides recommendations for reputed company managing opportunities. Minimum Requirements Minimum of bachelor's degree or higher in a health service-reputed company discipline. Five years of denial recovery experience or reputed company cycle reputed company field with a certificate in coding may be substituted. Previous auditing experience preferred. National Certification in an area relevant to reputed company Management or Coding is preferred. reputed company Set Requirement: Proficient in reimbursement methodologies, hospital information systems and coding methodologies. Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms. Ability to analyze reputed company medical records and identify billable services. Strong quantitative, analytical, and organizational skills. Understanding of medical records, professional/hospital claims, and the Charge master. Ability to utilize and understand computer technology. Ability to understand ancillary department functions. Possesses a comprehensive knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes. Possesses a working knowledge of the UB-04/837 claim reputed company reputed company and segments. Understands charging, coding processes along with compliance issues. Has the ability to reputed company resolutions by performing internet research, utilizing reputed company party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines. Requires knowledge of medical terminology, anatomy and physiology. Must be team-oriented with strong interpersonal skills. Knowledge of the Privacy Act to safeguard patient confidentiality. Certified Coding Specialist or Certified Procedural reputed company. Pay reputed company $27.22 - $39.68/hr Other Information Remote role (based out of Greenville, NC) Monday - Friday day shift:Start/end times flexible between 6:00 a.m. - 6:00 p.m. Great Benefits #LI-REMOTE #LI-AH2 reputed company About reputed company reputed company is a mission-driven, 1,708-bed academic health care system serving more than 1.4 reputed company people in 29 eastern reputed company Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship reputed company, a Level I Trauma Center, and reputed company Maynard Children¿s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. reputed company and the Brody School of Medicine reputed company a combined academic mission to improve the health and well-being of eastern reputed company Carolina through patient care, education and research. General Statement It is the goal of reputed company and its entities to reputed company the most reputed company individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of reputed company pre-employment screenings, which may include an occupational health screening, criminal record reputed company, education, reference, and licensure verification. We value diversity and are proud to be an equal opportunity employer. reputed company of employment are made based on business needs, job requirements and applicant¿s qualifications without regard to race, reputed company, religion, gender, national reputed company, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint. Apply To This Job