PRN Coding Denials Manager

CorroHealth

About The Position

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. As a member of the CorroHealth Denials Team, the Coding Denials Manager oversees the investigation and resolution of third-party insurance coding denials and edits for CorroHealth clients. The Manager also assists in the supervision of optimizing reimbursement by thoroughly researching and taking timely, appropriate action to ensure resolution of all coding denials. CorroHealth sits at the center of the revenue cycle revolution. Fundamental operations of the revenue cycle are supported through our expert teams while we recast the role of clinicians through automation. This shift to a true clinical revenue cycle helps us achieve our core purpose – exceed client financial health goals. For each patient population, CorroHealth automates key clinical aspects of the cycle. Our platforms focus on capture and application of clinical documentation while easing the burden on physicians. Scalability is prioritized in the support of client program operations. As with most revenue cycle partners, our skilled and enthusiastic team is available to outsource any portion of the cycle. However, we can also complement client programs with additional expert support or upskill existing client teams to meet program demands. Whether our team is deployed directly, or automation is incorporated for a more programmatic solution, CorroHealth delivers. CorroHealth has acquired Xtend Healthcare! For more information, please visit https://corrohealth.com. Applicants will only receive job-related emails from the domain @corrohealth.com. Additionally, it is important to emphasize that CorroHealth will never ask for money in return for a job offer.

Requirements

Must have a minimum of 3 years of coding experience preferably in profee surgeries, orthopedic, ophthalmology, neurology, trauma and more
Must have a strong background in Revenue Cycle Management
Requires strong computer skills, including Microsoft Office suite of products
National certification through AAPC or AHIMA required
MUST be certified through AHIMA (CCS, RHIT or RHIA)
Must have advanced working knowledge and experience with systems such as various EMR, Billing, etc.
Experience with Outlook, 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.

Responsibilities

Review 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
Identify root cause of the coding denial, resubmit claim and address/report the denial issue to leadership
Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews
Obtain and review 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
Comply 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
May be required to perform other duties as assigned by Leadership Team Member.