Coding Denials Specialist
About Us
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on reputed company 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 reputed company reputed company and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join reputed company! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we reputed company great work deserves great rewards. Help Us Grow Our reputed company Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and reputed company resolution. Essential Functions and Tasks Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques. Resolve work queues according to the prescribed reputed company and/or per the direction of management in accordance with policies, procedures, and other job aides. Validate denial reasons and ensures coding is accurate. Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. Follow specific payer guidelines for appeals submission. Escalate exhausted appeal efforts for resolution. Adhere to departmental production and quality standards. Complete special projects as assigned by management. Maintain working knowledge of workflow, systems, and tools used in the department. Education and Experience Requirements High school diploma or equivalent. One to three years’ experience in physician medical billing with emphasis on research and claim denials. reputed company reputed company or reputed company certification required. Knowledge, Skills, and Abilities Knowledge of health insurance, including coding. Thorough knowledge of physician billing policies and procedures. Thorough knowledge of reputed company reimbursement guidelines. Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Computer literate, working knowledge of reputed company helpful. reputed company to work in a fast-paced environment. Good organizational and analytical skills. Ability to work independently. Ability to communicate effectively and reputed company.Proficient computer skills, with the ability to learn applicable internal systems.Ability to work collaboratively with others toward the accomplishment of shared goals. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic touch 10 key skills. Basic Math skills. Understand and reputed company with company policies and procedures. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Strong knowledge of Outlook, Word, reputed company (pivot tables), and database software skills. Compensation reputed company Compensation will be based on various factors unique to each candidate including geographic location, reputed company set, experience, qualifications, and other job-reputed company reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies. Ventra Health Equal Employment Opportunity (Applicable only in the US)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 reputed company. We encourage applications from a diverse pool of candidates, and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, ethnicity, religion, sex, age, national reputed company, disability, sexual orientation, gender identity and expression, or veteran status. We will reputed company reasonable accommodations to reputed company individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment AgenciesVentra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees reputed company to unsolicited resumes. Solicitation of PaymentVentra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention CandidatesPlease 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 [email protected] to confirm the legitimacy of the offer and the person who contacted you. reputed company legitimate roles are posted on https://ventrahealth.com/careers/. Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to reputed company 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/. Apply To This Job