Serves as the dynamic denial management coding analyst to maintain a low denial rate and high reimbursement rate at an enterprise level. To maintain a high coding standard within the enterprise. Organizes and plans projects to improve effectiveness of dynamic coding, reimbursement rates, and appeal turnover rates. Performs analysis for denial trend improvement to include EPIC system edits, coding validation, CDM processes that affect reimbursement, authorization trends and performance improvement, and payer denial trends. Educates departments on appropriate charging/billing/coding issues to ensure regulatory compliance. Works with managed care and compliance to resolve issues with departments and payers.
Required Education::
High School Diploma or GED
Required Licensure/Certification::
At least one of the following coding certifications required: CPC, COC, RHIT, RHIA, CCS or CCA.
Required Experience::
1-2 years coding experience AND 1-2 years denial and insurance experience
Preferred Experience::
Experience related to coding, medical record review, auditing, insurance experience.
Necessary Skills::
1. Demonstrated knowledge of: Hospital billing and reimbursement, Medicare and Medicaid denials and appeals, third-party contracts, federal and state regulations governing the healthcare industry
2. Excellent critical thinking and analytical skills
3. Attention to detail and ability to complete the job with minimal errors and work independently.
4. Proficient organizational skills
5. Excellent writing and communication skills
6. Ability to prioritize and manage time effectively.
7. Proficient in Microsoft Office Products such as: Outlook, Word, Excel
8. Knowledge of HIPPA guidelines
9. Ability to read and interpret EOB’s.
10. Strong research and problem-solving skills
11. High level of comfort with computer systems