Professional Physician Services Coding Denial Analyst (1.0)
About The Position
The Professional Physician Services Coding Denial Analyst is responsible for addressing coding related denials across Franciscan Alliance. Additionally, the Coding Denial Analyst monitors denial results and notifies Coding Leadership of any identified trends. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Reviews, researches, and responds to inquiries, denial management, and follow-up questions, according to Coding Department approved resources. Reviews and processes claims and edits for accuracy and insurance and coding compliance. Utilizes official coding guidelines and follows established policies and procedures, to determine accurate code selection based upon documentation in the medical record. Acts as a subject matter expert for coding, billing and payer edits and denials. Assesses and ranks denials priority to align with Rev Cycle goals. Assesses denial and takes action to adjust claim data and resubmit corrected claim, prepare and coordinate appeal response, and prepare avoidable write off documentation. Collaborates with coding leadership, to improve key performance indicators through trending denials. Coordinates timely response to denials, reaching out to other Franciscan Alliance departments, as well as payers, when necessary, through denial resolution. Recommends improvements/adjustments to workflow and system build in response to changes in reimbursement methodology, coding guidelines, regulatory standards, or department workflow changes to prevent denials.
Requirements
- High School Diploma/GED - Required
- 3 years Coding - Required
- CCS - Certified Coding Specialist - American Health Information Management Association (AHIMA) - Required or CCS-P - Certified Coding Specialist - Physician - American Health Information Management Association (AHIMA) - Required or CPC - Certified Professional Coder - American Academy of Professional Coders (AAPC) - Required
Nice To Haves
- Associate or Bachelor's Degree Healthcare Information Management - Preferred
- 1 year Coding Denials/Payer Experience - Preferred
- Demonstrated experience in surgical operative coding, including accurate interpretation of surgical guidelines, modifiers (co-surgeon and assistant surgeon), and surgeon billing requirements - Preferred
- RHIT - Registered Health Information Technician - American Health Information Management Association (AHIMA) - Preferred
- RHIA - Registered Health Information Administrator - American Health Information Management Association (AHIMA) - Preferred
Responsibilities
- Reviews, researches, and responds to inquiries, denial management, and follow-up questions, according to Coding Department approved resources.
- Reviews and processes claims and edits for accuracy and insurance and coding compliance.
- Utilizes official coding guidelines and follows established policies and procedures, to determine accurate code selection based upon documentation in the medical record.
- Acts as a subject matter expert for coding, billing and payer edits and denials.
- Assesses and ranks denials priority to align with Rev Cycle goals.
- Assesses denial and takes action to adjust claim data and resubmit corrected claim, prepare and coordinate appeal response, and prepare avoidable write off documentation.
- Collaborates with coding leadership, to improve key performance indicators through trending denials.
- Coordinates timely response to denials, reaching out to other Franciscan Alliance departments, as well as payers, when necessary, through denial resolution.
- Recommends improvements/adjustments to workflow and system build in response to changes in reimbursement methodology, coding guidelines, regulatory standards, or department workflow changes to prevent denials.
Benefits
- Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
