Coding Edits & Denials Specialist

CorroHealth

About The Position

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.

Requirements

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.

Responsibilities

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