Coding Edits & Denials Specialist

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Job Description Summary

As a member of the CorroHealth Denials team, the Coding Denial Specialist is responsible for investigating and resolving third-party insurance coding denials and edits for CorroHealth clients. The Coding Denial Specialist also assist in optimizing reimbursement by thoroughly researching and taking the appropriate action to resolve all coding denials in a timely manner.

Job Description

• • Reviews and research coding denials that have been received as no payment/previous submitted claims with a denied or no response for payors and service areas

  • Identifies root cause of the coding denial, resubmit claim and address/report the denial issue to the supervisor

  • Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews

  • Obtains and reviews medical records through EMR, site request or hospital portals for reconsideration purposes

  • Utilizes all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal denied claims

  • Complies with adjustment and appeal or reconsideration in conjunction with each service area's Coding and Reimbursement guidelines

  • Effectively utilizes ICD 10 CM and CPT codes and related material to investigate and ensure that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims

  • Organizes work/resources to accomplish objectives and meet timely filing deadlines

  • Demonstrates problem-solving skills related to coding denial analysis

  • Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively, to obtain necessary information to address denial issues

  • Meets productivity requirements to ensure excellent service is provided to customers

  • Adheres to compliance and corporate and departmental policies and procedures

  • Identifies all coding denial trends and provide education of steps to prevent future avoidable denials

  • Initiates and responds all coding appeals in a timely manner

  • Logs and tracks all coding denial trends and coding denial increases on coding log

  • Completes special projects as assigned by Director

  • Maintains and utilizes accurate and current coding resource materials when making determinations for claim reconsiderations and appeals

  • Performs other projects and duties as related to the overall organization's objectives

  • Maintains confidentiality of all information as stipulated in the HIPAA Privacy Rules and Company Confidentiality Policy

  • Maintain daily and monthly productivity goals – set depending on service area/payor assignment

  • Other duties as assigned

  • At least 3 years of pervious coding experience preferred in profee surgeries, orthopedic, ophthalmology, neurology, trauma and many more

  • Computer skills, including Microsoft Office suite of products

  • Data entry skills of 40 WPM required

  • National certification through AAPC or AHIMA

  • All coders MUST be certified through AHIMA (CCS, RHIT or RHIA)

  • Must have advanced working knowledge and experience with systems such as EMR, Billing, etc.

  • Outlooks you should be able to manage emails and schedule and attend meetings.

  • Must have current coding materials such as CPT and ICD-10-CM coding references.

  • Regular, predictable, and punctual attendance is required.

  • Will be required to maintain an ongoing productivity level and accuracy rate of 95% or higher.

  • Ability to communicate effectively and professionally both verbally and written.

  • Ability to coordinate, analyze, observe, make decisions, and meet deadlines.

  • May be required to perform other duties as assigned by Leadership Team Member.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.