Clinical Denial Coding Review Specialist

HCA•Plano, TX

34d

About The Position

The Clinical Denials Coding Review Specialist is responsible for applying correct coding guidelines and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job requires regular outreach to payors and Practices. In this role you will: Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate Compose technical denial arguments for reconsideration, including both written and telephonically Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument Identify problem accounts/processes/trends and escalate as appropriate Utilize effective documentation standards that support a strong historical record of actions taken on the account Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information Update patient accounts as appropriate Submit uncollectible claims for adjustment timely and correctly Resolve claims impacted by payor recoupments, refunds, and posting errors Assist team members with coding questions and provide resolution guidance Provide coding guidance and support to Practices Meet and maintain established departmental performance metrics for production and quality Maintain working knowledge of workflow, systems, and tools used in the department

Requirements

Minimum two years related experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical/billing, medical payment posting, and/or cash application.
Prior experience reading and interpreting Explanation of Benefits (EOB) required

Nice To Haves

Coding certification through AHIMA or AAPC strongly preferred

Responsibilities

Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures
Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate
Compose technical denial arguments for reconsideration, including both written and telephonically
Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
Identify problem accounts/processes/trends and escalate as appropriate
Utilize effective documentation standards that support a strong historical record of actions taken on the account
Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information
Update patient accounts as appropriate
Submit uncollectible claims for adjustment timely and correctly
Resolve claims impacted by payor recoupments, refunds, and posting errors
Assist team members with coding questions and provide resolution guidance
Provide coding guidance and support to Practices
Meet and maintain established departmental performance metrics for production and quality
Maintain working knowledge of workflow, systems, and tools used in the department

Benefits

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan with 10% off HCA Healthcare stock
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more
Consumer discounts through Abenity and Consumer Discounts
Retirement readiness, rollover assistance services and preferred banking partnerships
Education assistance (tuition, student loan, certification support, dependent scholarships)
Colleague recognition program
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.