Coder - Denials
Posted on May 4, 2021 by CHI Health Clinic
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U. S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U. S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities REMOTE OPPORTUNITY AFTER 6 MONTH TRAINING PERIOD! Job Summary / Purpose
Under direct supervision, this position is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements. The incumbent conducts follow-up process activities through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
- Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
- Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
- Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
- Resubmits claims with necessary information when requested through paper or electronic methods.
- Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
- Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
- Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
- Assists with unusual, complex or escalated issues as necessary.
- Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
- Accurately documents patient accounts of all actions taken in billing system.
- Other duties as assigned by management.
- Knowledge of health insurance, including coding.
- Ability to communicate effectively and efficiently.
- Proficient computer skills, with the ability to learn applicable internal systems.
- 1+ years coding experience.
- Insurance follow up experience.
- Completion of ICD-10 or CPT coding course highly preferred
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