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Coding Denials Resolution Specialist
Location
United States
Posted
5 days ago
Salary
0
Seniority
Senior
Job Description
Coding Denials Resolution Specialist
Healthrise
• Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations. • Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials. • Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. • Promotes departmental awareness of coding best practices.
Job Requirements
- High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four (4) years of experience within a hospital or clinic environment, health insurance company, managed care organization, or other healthcare financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities; or an equivalent combination of education and experience.
- Experience in a complex, multi-site environment preferred.
- Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as typically obtained through a coding certificate program, and at least one (1) year of physician/professional and hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.
- Must hold one of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC). Certified Professional Medical Auditor (CPMA) will also be considered.
- Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
- Possesses detailed understanding of principles, methods, and techniques related to compliant healthcare billing/collections.
- Demonstrates expertise in medical terminology, disease processes, patient health record content, and the medical record coding process.
- Must be comfortable operating in a collaborative, shared leadership environment. Previous experience working with Global Partner vendors is preferred.
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