Denials Coder

CommonSpirit Health•Omaha, NE

19h

About The Position

From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours. Job Summary and Responsibilities As a Medical Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements. Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal. Resubmits claims with necessary information when requested through paper or electronic methods. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

Requirements

High School Graduate General Studies and 1+ years coding experience, upon hire or High School GED Generals Studies and 1+ years coding experience, upon hire and Associates Other in related field and Insurance follow up experience, upon hire and Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology., upon hire and Completion of ICD-10 or CPT coding course., upon hire
Certified Professional Coder, upon hire or Certified Professional Coder Hospital Apprentice, upon hire or Certified Professional Coder Apprentice, upon hire or Certified Coding Associate, upon hire or Cardiology Coding, upon hire or Certified Coding Specialist, upon hire or Certified Coding Specialist - Physician Based, upon hire or Certified Cardiovascular and Thoracic Surgery Coder, upon hire or Certified Health Care Compliance, upon hire or Certified Interventional Radiology Cardio Coder, upon hire or Certified Professional Coder Hospital, upon hire or Radiology Certified Coder, upon hire or Registered Health Information Administrator, upon hire or Registered Health Information Technician, upon hire

Responsibilities

Ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Apply a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices.
Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc.
Communicate with provider to resolve claims that require a written appeal or second level appeal.
Resubmit claims with necessary information when requested through paper or electronic methods.
Anticipate potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
Recognize when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.