Profee Medical Coding Denial Specialist

Guidehouse•Birmingham, AL

2d•$38,000 - $64,000•Remote

About The Position

The Coding Denial Specialist will review assigned coding denials across multiple specialties, determine root cause and following established client workflow resolve and/or appeal denials based on clinical documentation and diagnostic results in alignment with Federal & State Coding regulations; including the National Correct Coding Initiative, CPT, HCPC’s and ICD10 CM Guidelines This position is full time and is 100% remote. Triage incoming coding denial inventory, validating appeal criteria is met in compliance with departmental policies and procedures Compose technical denial arguments for reconsideration and appeal 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 Resolve claims impacted by payor recoupments, refunds, and posting errors Assist team members with coding questions and provide resolution guidance Meet and maintain established performance metrics for production and quality Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. Responsible for coding or pending every chart placed in their queue within 24 hours. It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. Coders must maintain their current professional credentials while working for Guidehouse. Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content. Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.

Requirements

High School Diploma or equivalent
1+ years Physician Coding experience
1+ years Physician Coding Denial Management experience
CPC certification from AAPC
Must maintain credential throughout employment
High level of accuracy and attention to detail
Strong Working Knowledge of Federal & State Coding regulations; including the National Correct Coding Initiative
Strong working knowledge of CPT, HCPC’s and ICD10 CM Guidelines
Good working knowledge of HIPAA regulations, hospital operations, and working with electronic health record (EHR) systems such as EPIC or Cerner

Nice To Haves

AAPC specialty credential(s)
Proficient in the interpretation of Claim Adjustment and Remittance Advice Reason Codes
Excellent verbal, written and interpersonal communication skills
Basic knowledge of Excel, Word and PowerPoint
Strong critical thinking, analytical, and communication skills, with an attention to detail and the ability to work in a fast-paced environment independently or collaboratively

Responsibilities

Triage incoming coding denial inventory, validating appeal criteria is met in compliance with departmental policies and procedures
Compose technical denial arguments for reconsideration and appeal
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
Resolve claims impacted by payor recoupments, refunds, and posting errors
Assist team members with coding questions and provide resolution guidance
Meet and maintain established performance metrics for production and quality
Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing
Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes.
When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards.
Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process.
Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met.
Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility.
Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request.
Responsible for coding or pending every chart placed in their queue within 24 hours.
It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard.
Coders are responsible for checking the Guidehouse email system at least every two hours during coding session.
Coders must maintain their current professional credentials while working for Guidehouse.
Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility.
Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content.
Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program