Coder - Denials
Posted on Apr 16, 2019 by CHI Health
Scheduled Hours per 2 week Pay Period: 80
Primary Location: NE > LINCOLN > THE PHYSICIAN NETWORK
Your time at work should be fulfilling. Rewarding. Inspiring. That s what you ll find when you join one of ournon-profit CHI facilities across the nation. You ll find challenging, rewardingwork every day alongside people who have as much compassion as you. Join us andtogether we ll create healthier, stronger communities. Imagine your careerat Catholic Health Initiatives!
This job is responsible for corresponding with both commercial and governmenthealth insurance payers to address and resolve outstanding insurance balancesrelated to coding denials in accordance with established standards, guidelinesand requirements. An incumbent conductsfollow-up process activities through review of medical records and contact withproviders, phone calls, online processing, fax and written correspondence,leveraging work queues to organize work efficiently. Work also includes reviewing insuranceremittance advices, researching denial reasons and resolving issues throughwell-written appeals.
Work requires proactive troubleshooting,significant attention to detail and the application of analytical/criticalthinking skills to analyze denials and reimbursement methodologies and bringtimely resolution to issues that have a potential impact on revenues.
Additional responsibilities for this health care role include:
Follows-upwith insurance payers to research and resolve unpaid insurance accountsreceivable; makes necessary corrections in the practice management system toensure appropriate reimbursement is receive.
- Applies a thorough understanding/interpretationof Explanation of Benefits (EOBs) and remittance advices, including when andhow to ensure that correct and appropriate payment has been received.
- Communicates effectively overthe phone and through written correspondence to explain why a balance isoutstanding, denied and/or underpaid using accurate and supported reasoningbased on EOBs, reimbursement, and payer specific requirements.
- Review patient medical recordto compare documentation and coding; change coding based on documentation toinclude diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claimsthat require a written appeal or second level appeal.
- Resubmits claims with necessaryinformation when requested through paper or electronic methods.
- Anticipates potential areas ofconcern within the follow-up function; identify issues/trends and conductsstaff training to address and rectify.
- Recognizes when additionalassistance is needed to resolve insurance balances and escalates appropriatelyand timely through defined communication and escalation channels.
- Resolves work queues accordingto the prescribed priority and/or per the direction of management and inaccordance with policies, procedures and other job aides.
- Assists with unusual, complexor escalated issues as necessary.
- Three years of revenue cycle or related work experience that demonstratesattainment of the requisite job knowledge and abilities.
- High school/GED
- Graduation from a post-high school program in medical billing or otherbusiness-related field is preferred.
- Certification (AHIMA, CPC, or CCS-P)
- 2 years coding experience
- Requisition ID: 2019-R
- Schedule: Full-time
- Market: CHI Lakewood Health