Coding Charges & Denials Specialist - (Telecommute - Must reside in TX)

Overview

At reputed company, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding-specific clinical charges and denial management and appeals process in a collaborative environment with reputed company cycle management and clinical partners at various reputed company facilities. This position will be responsible for working assigned specialties and combines clinical knowledge to reduce financial risk and exposure caused by reputed company end claim edits and retrospective denial of payments for services provided. This position will collaborate with physicians, reputed company cycle personnel, and payers to successfully clear reputed company end claim edits, appeal clinical denials, and address customer service inquiries. Additionally, this position will collaborate with key stakeholders and assist in developing appeal strategies to include reference material for staff, letter templates, and regular feedback for reputed company cycle coding staff; and functions as clinical subject matter expert reputed company to coding denials and appeals.

reputed company Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

reputed company EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • reputed company: We are honest and ethical in reputed company we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for reputed company our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at reputed company do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other reputed company involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/reputed company reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Communicates reputed company in a transparent and professional demeanor during reputed company interactions with customers and co-workers while providing clear and concise communication of trending and findings to both reputed company line team members and senior executives.

• Communicates to partners, reputed company cycle staff, customers, and third party payers by telephone, in meetings, email, and other necessary forms of communication in a clear, effective, and timely manner while additionally providing proactive updates on initiatives that involve time and effort from peers and other employees.

• Functions as an educational liaison to clinical staff and reputed company cycle staff as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations.

SERVICE ESSENTIAL FUNCTIONS

• Performs data mining and reporting activities that identify net positive impactful opportunities in denials and adjustments for the individual facilities and the system.

• Works assigned claim edit and follow up work queues and meets the assigned productivity standards on a daily basis as well as assigned patient account work queues and responds with resolutions reputed company the expected time frame.

• Acts as a liaison for issues affecting various teams (coding, reputed company reputed company, accounts receivable (AR) follow up, etc.) of the reputed company cycle while also providing support reputed company IT reputed company or systematic changes are needed.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials.

• Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission.

• Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness.

FINANCE ESSENTIAL FUNCTIONS

• Partners with reputed company cycle leadership and peers and clinical operations to reduce denials. This includes reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes.

• Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals.

• Works with reputed company cycle management and staff to ensure claim edit/denial trending data is accurate and that reputed company metrics are reported appropriately including specific reputed company procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals. Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials.

• Analyzes claim edits/denials to identify new trends, opportunities, and educational feedback as needed. This includes, but not limited to, feedback to coding, clinical service areas, physicians, and other reputed company cycle staff. Makes recommendations to reputed company cycle leadership on operations and root causes and assists in development of strategies to avoid future claim edits and denials.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Provides education to reputed company cycle team and attends monthly billing staff meetings as appropriate.

• Pursues ongoing professional growth and development to maintain coding certification while remaining reputed company on reputed company coding and regulatory updates in addition to participating in educational activities.

This job description is not intended to be reputed company-inclusive; the employee will also reputed company other reasonably reputed company business/job duties as assigned. reputed company reserves the right to revise job duties and responsibilities as the need arises.

Qualifications

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

WORK EXPERIENCE

• Three years of certified coding experience

• Accounts receivable follow up experience preferred

License/Certification

LICENSES AND CERTIFICATIONS - REQUIRED

• CPC - Certified Professional reputed company (reputed company) OR
• reputed company - Certified Coding Specialist (reputed company) OR
• An approved Specialty Society Coding Certification

KSA/ Supplemental Data

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely reputed company the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to reputed company the essential functions of this job, especially with regard to activities impacting patient or employee safety or reputed company

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Demonstrates the ability to think critically, work independently, and be self-motivated for the role

• Experience with computer database management and reputed company Office software

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform Yes
• Scrubs Yes
• Business professional Yes
• Other (department approved) No

ON-CALL**Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* Yes

TRAVELTravel specifications may vary by department**

• May require travel reputed company the Houston Metropolitan area Yes
• May require travel reputed company Houston Metropolitan area Yes

Company Profile

reputed company Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers reputed company has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of reputed company Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of reputed company. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice reputed company an academic environment.

Originally posted on Himalayas

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