PB RI Denials Spec / PB Coding

Hartford Healthcare•Farmington, CT

About The Position

The PB Revenue Integrity Denials Specialist is responsible for review and research of professional coding denials and identification of root causes for resolution to improve timely revenue recovery. Utilizes expert problem-solving skills to resolve complex billing issues, unpaid claims and customer complaints, taking all steps and coordinating corrective action to ensure full resolution of prompt payment.

Requirements

Associate’s degree or equivalent work experience
3-5 years of experience with professional Coding denial/avoidable write-off (or healthcare experience)
CPC, CCS-P certification required and maintained thereafter
Strong written and verbal communication skills.
Strong knowledge of coding concepts
ICD‑10‑CM diagnostic and CPT/HCPCS procedure codes & Modifiers
Clinical information related to areas of responsibility
Microsoft Office Products; Word, Excel
Encoder
Knowledge and understanding of insurance claim processing and third-party reimbursement.
Knowledge and understanding of insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes
Knowledge of healthcare related financial and/or accounting practices.
Skill in effective oral, written, and interpersonal communication.
Skill in problem-solving in a variety of settings and translation of data into actionable steps.
Skill in time management
Ability to prioritize and escalate issues.
Ability to work comfortably with revenue cycle leadership, practice personnel and providers across the Hartford HealthCare System
Ability to work with a variety of stakeholders at multiple organizational levels
Ability to read, understand and interpret, analyze, and apply complex regulatory requirements.
Ability to operate a computer and related applications.
Ability to work independently and take initiative.
Ability to handle multiple priorities

Responsibilities

Work key workques related to Coding denials and Customer Service Complaints
Review and research Customer Service Coding Complaints and bring to resolution
Review and research coding denials related to medical necessity, Coding and identify root causes for resolution
Review Medical records for reconsideration purposes
Evaluates denials against medical record documentation, the coding of the encounter, payer policies to determine if coding corrections are needed or the denial can be appealed
Analyzes medical records, interprets documentation and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD‑10‑CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software encoder, coding manuals and other reference material as required.
Demonstrates in-depth understanding of Medicare, Medicaid and private payors, policies and guidelines
Researches and resolves denials making appropriate decisions on accounts to optimize reimbursement
Accurately document all account activity in Epic.
Adheres to all department coding/charging procedures, policies, guidelines and quality standards.
Assists manager with special projects/other tasks as assigned
Abides by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adheres to official coding guidelines.
Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).
Proactively identifies opportunities for revenue cycle improvement initiatives to prevent future denials/Avoidable Write offs (AWOs) and improve timely revenue recovery. Collaborate with leadership and other key stakeholders to make solution recommendations. Examples include but not limited to Education for clinicians and or coders or new EPIC edits to prevent denials.
Maintains appropriate Standard Work documentation related to denials & customer service work
As assigned, assists in training new colleagues to become acclimated to the environment and in understanding internal policies and procedures, and documentation guidelines.