Denial Coding Analyst at Franciscan Health
Denial Coding Analyst
- Hospital Coding
- Franciscan Alliance
- Work From Home
- 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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