Coding Denials Resolution Specialist

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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Healthrise

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • Consulting • SaaS

Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized.

📋 Description

• 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.

🎯 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.