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Coding Denials Specialist

Location

United States

Posted

82 days ago

Salary

PEN220K - PEN310K / year

Seniority

Mid Level

Job Description

Coding Denials Specialist

Ventra Health

Role Description The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work queues. Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution. - Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned queues. - Resolve work queues according to the prescribed priority 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. Qualifications - High school diploma or equivalent. - One to three years’ experience in physician medical billing with emphasis on research and claim denials. - Current AAPC or AHIMA certification required. Requirements - Knowledge of health insurance, including coding. - Thorough knowledge of physician billing policies and procedures. - Thorough knowledge of healthcare 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 Excel helpful. - Able to work in a fast-paced environment. - Good organizational and analytical skills. - Ability to work independently. - Ability to communicate effectively and efficiently. - 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 comply with company policies and procedures. - Strong oral, written, and interpersonal communication skills. - Strong time management and organizational skills. - Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. Compensation - Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. - This position is also eligible for a discretionary incentive bonus in accordance with company policies. Equal Employment Opportunity 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 paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Job Requirements

  • High school diploma or equivalent.
  • One to three years’ experience in physician medical billing with emphasis on research and claim denials.
  • Current AAPC or AHIMA certification required.
  • Knowledge of health insurance, including coding.
  • Thorough knowledge of physician billing policies and procedures.
  • Thorough knowledge of healthcare 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 Excel helpful.
  • Able to work in a fast-paced environment.
  • Good organizational and analytical skills.
  • Ability to work independently.
  • Ability to communicate effectively and efficiently.
  • 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 comply with company policies and procedures.
  • Strong oral, written, and interpersonal communication skills.
  • Strong time management and organizational skills.
  • Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
  • Compensation
  • Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
  • This position is also eligible for a discretionary incentive bonus in accordance with company policies.
  • Equal Employment Opportunity
  • 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 paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

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