Acute Coding Appeals Specialist

🕒 June 15

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

💰 Private Equity Round on 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals/denials activities. • Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise to determine potential billing/coding issues, and quality concerns. • Participates in client system education to gain the knowledge necessary to appeal client accounts. • Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. • Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations to identify requirements to make recommendations to client. • Assist in education and training for client coding companions. • Meet established productivity standards for coding appeals & coding certification requirement. • Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.

🎯 Requirements

• Previous inpatient facility coding experience, working appeals, denials and edits • 5 years previous experience in coding, required • Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits • Career Advancement