Company Background 

Emerald Therapy Center, LLC is a multi-disciplinary behavioral health organization in Paducah, Kentucky. Our mission is to provide clients with counseling, medication management and addiction treatment services to function at their highest level. We opened our first office in Paducah, KY, in the fall of 2014. Since then, Emerald Therapy Center, LLC. has seen tremendous growth, and the need for more services and programs was quickly recognized. The owners have continued to diligently work towards expanding services and making Emerald the most certified and credentialed behavioral health organization in Western Kentucky. We can assess, diagnose, and treat adults, teens, and children. Various treatment options from individual, group, and family therapy are offered. Sessions may be conducted at our main office location, various facilities that we partner with, or within the community. Emerald Therapy Center, LLC., promotes emotional, physical, spiritual, and financial wellness by directing other resources to clients to live their healthiest and most productive lives. We use these four areas of wellness to help clients function at their highest level. We promote that our services should be uplifting and encouraging. We want our clients to leave our facility feeling better than when they came in, regardless of the issue.

We are all on a journey to experience to achieve the best life possible.

“Your Best Days are ahead.”

• Performs advanced level work related to insurance denial management.
• Responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned.
• Conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is needed.
• Writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.
• Handles audit-related / compliance responsibilities and other administrative duties as required.
• Actively manages, maintains, and communicates denial/appeal activity to the RCM Director and reports suspected or emerging trends related to payer denials to Revenue Cycle management.
• Accounts for coding and abstracting of patient encounters, including procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• Analyzes medical records and identifies documentation deficiencies.
• Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies documentation supporting diagnoses, procedures, and treatment results.
• Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research, and compliance with regulatory requirements utilizing guidelines.
• Follows coding conventions. Serves as a coding consultant to care providers.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Serves as resource and subject matter expert to other coding staff.
• Assists lead or supervisor in orienting training, and mentoring staff.
• Provides ongoing training to staff as needed.
• Handles special projects as requested.
• Proficient in Excel Sorting, Pivots, and VLOOKUP
• This is not a Remote Position

Education, Experience, and Licensing Requirements:

• High school diploma, GED, or equivalent
• University/college degree, or experience medical records, claims or billing areas is an asset.
• CCA (AHIMA) CCS (AAPC) or greater