Summary:

Responsible for monitoring denial work queues within EPIC to ensure timely corrections and appeal deadlines are met.

Must have the ability to understand and apply critical thinking skills to ascertain the root cause for each denial.

Generates timely, accurate and effective appeals when appropriate. Works collaboratively with the CBO to develop and maintain appropriate and timely denial management processes.

Perform trend analyses to identify patterns and variations in coding denials and practices. Monitors payer response to appeal activity.

Maintain open communication with CTC physician practices to facilitate denial/appeals review process.

Acts as a resource to other coding staff in regards to denials, appeals process and provides assistance and guidance as necessary.

Participates in departmental and key leadership presentations to provide status reports on claim denials and appeals.

Provide feedback to physicians and management in a timely and professional manner.

Maintain knowledge of managed care, commercial, governmental and Medicare payors' clinical documentation, coding and billing guidelines.

Requirements:

• Minimum requirements: Completion of an AAPC or AHIMA approved Coding Certificate Program; High school diploma or GED; Associate/Bachelor degree in Business or Healthcare preferred
• Minimum 5 years of professional billing, claim denials, appeals, and revenue cycle work
• Minimum 2 years of physician practice coding in an outpatient clinic setting
• Expert knowledge of CPT, ICD-10, HCPCS, and medical terminology
• Expert knowledge of Medicare, Medicaid, and Commercial payers coding/billing guidelines and compliance regulations, including medical policy restrictions (LCDs and NCDs)
• Exceptional written and verbal communication skills
• Experience in data analysis and the ability to create denial trend reports
• Strong analytical, organizational, and research skills, with extreme attention to detail
• Proficient using multiple software applications, including: Excel, Word, Access, and PowerPoint
• Ability to prioritize assignments to meet deadlines
• Ability to meet set productivity and quality standards
• Able to work independently in a remote setting, as well as part of a team
• EPIC and Meditech experience preferred
• One of the following certifications is required:
• Certified Professional Coder (CPC) – AAPC
• Certified Professional Biller (CPB) – AAPC
• Certified Coding Specialist (CCS) – AHIMA
• Certified Coding Associate (CCA) - AHIMA

Work Type: 

Full Time