Denial Coding Analyst at Franciscan Health

Remote
Franciscan Health

Denial Coding Analyst

  • Hospital Coding
  • Franciscan Alliance
  • Work From Home
  • Full-Time
  • Associates Preferred

WHAT WE NEED

Accurate coding extraordinaire

WHO WE ARE LOOKING FOR

High quality health care is both a calling and a business. And the business side identifies trends and looks for ways to reduce denials. Bottom line: this job is important for back-end operations.
Are you accurate and detail-oriented? Do you have experience working in health care? We’ve got a place where your skills are needed and ultimately help provide the best health care to our patients.

WHAT YOU WILL DO

  • Review, research, and respond to customer service, denial management, and follow-up questions according to Coding Department approved resources.
  • Review and process claims and edits for accuracy and insurance and coding compliance.
  • Utilize official coding guidelines and follow established policies and procedures to determine accurate code selection based upon documentation in the medical record.
  • Act as a subject matter expert for coding, billing and payer edits and denials.
  • Assess and rank denials priority to align with Rev Cycle goals.
  • Assess denial and take action to adjust claim data and resubmit corrected claim, prepare and coordinate appeal response, and prepare avoidable write off documentation.
  • Collaborate with coding leadership to improve key performance indicators through trending denials.
  • Coordinate timely response to denials, reaching out to other Franciscan Alliance departments as well as payers when necessary through denial resolution.
  • Recommend 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.

WHAT IT TAKES TO SUCCEED

  • CCS, RHIT or RHIA Required
  • Prior Coding experience.
  • Prior experience in Coding Denials/Payer.
  • Knowledge of types of health information and the rules and regulations surrounding their use.
  • Advanced understanding of ICD10CM coding, ICD10PCS coding, CPT coding, and coding guidelines.
  • Advanced understanding of coding grouping methodologies.
  • Understanding of payer relationships, requirements and compliant billing practices and role of the Healthcare provider related to insurance processes.
  • Knowledge of Managed Care requirements under the Medicare/Medicaid and other third party payor programs.
  • Understanding of common medical terminology, anatomy and physiology and terminology used in diagnosis and classification of illnesses, injuries, and disabilities.
  • Knowledge of pharmaceutical terminology, generic and trade names, and ICD coding.
  • Understanding of anatomy and physiologic concepts as they relate to relevant diagnostic testing and course of treatment.
  • Critically evaluate and analyze information in written materials.
  • Solve problems by analyzing information and using logic to address issues and problems.
  • Proficient in Microsoft Office Applications.
  • Effectively communicate verbally and in writing as appropriate for the needs of the audience.

WHAT WE’RE LOOKING FOR

  • 3 Years Coding Experience Required, Coding Denials Experience Preferred
  • Certification(s): CCS, RHIT or RHIA Required

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