Clinical Denials Coding Review Specialist

HCA Healthcare • Brentwood, TN

123d • Remote

About The Position

As a work from home Clinical Denials Coding Review Specialist, you will be 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.

Requirements

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

Benefits

• Comprehensive medical coverage that covers many common services at no cost or for a low copay
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans, 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
• 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

What This Job Offers

• Industry: Hospitals