Thank you for considering a career at Ensemble Health Partners!
CAREER OPPORTUNITY OFFERING:
· Bonus Incentives
· Paid Certifications
· Tuition Reimbursement
· Comprehensive Benefits
· Career Advancement
The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for outpatient coding and inpatient Diagnosis Related Group, (DRG) denials in order to support the assigned DRG and to address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes.
Job Responsibilities:
- The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns
- Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate
- 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, guidelines to identify and coding and billing requirements to make recommendations to client
- Assist in the development and coordination of the executive summary reports, education and training client coding companion as it relates to the outcomes of the coding appeals
- Meet established productivity standards for coding appeals & coding certification requirement
- Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations
- Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude
Experience We Love:
- Previous outpatient facility coding experience, working appeals, denials and edits
- 5 years previous experience in coding, required
- Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.)
- Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
#INDMP
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work setting:
Experience:
- Coding: 5 years (Required)
License/Certification:
- One of these is required: RHIA, RHIT, CCS, CIC, CPC, or COC? (Required)
Work Location: Remote