The Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding specific clinical and hospital charges and denial management and appeals process in a collaborative environment with revenue cycle management and clinical partners of the hospital system.

• This position will be responsible for working assigned specialties and combines clinical knowledge to reduce financial risk and exposure caused by front end claim edits and retrospective denial of payments for services provided
• This position will collaborate with physicians, revenue cycle personnel, and payers to successfully clear front end claim edits, appeal clinical denials, and address customer service inquiries
• Additionally, this position will collaborate with key stakeholders and assist in developing appeal strategies to include reference material for staff, letter templates, and regular feedback for revenue cycle coding staff; and functions as clinical subject matter expert related to coding denials and appeals
• Communicates openly in a transparent and professional demeanor during all interactions with customers and co-workers while providing clear and concise communication of trending and findings to both front line team members and senior executives
• Communicates to partners, revenue cycle staff, customers, and third party payers by telephone, in meetings, email, and other necessary forms of communication in a clear, effective, and timely manner while additionally providing proactive updates on initiatives that involve time and effort from peers and other employees
• Functions as an educational liaison to clinical staff and revenue cycle staff as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations
• Performs data mining and reporting activities that identify net positive impactful opportunities in denials and adjustments for the individual facilities and the system
• Works assigned claim edit and follow up work queues and meets the assigned productivity standards on a daily basis as well as assigned patient account work queues and responds with resolutions within the expected time frame
• Acts as a liaison for issues affecting various teams (coding, revenue integrity, accounts receivable (AR) follow up, etc.) of the revenue cycle while also providing support when IT related or systematic changes are needed
• Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials
• Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission
• Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness
• Partners with revenue cycle leadership and peers and clinical operations to reduce denials
• This includes reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes
• Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals
• Works with revenue cycle management and staff to ensure claim edit/denial trending data is accurate and that all metrics are reported appropriately including specific current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals
• Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials
• Analyzes claim edits/denials to identify new trends, opportunities, and educational feedback as needed
• This includes, but not limited to, feedback to coding, clinical service areas, physicians, and other revenue cycle staff
• Makes recommendations to revenue cycle leadership on operations and root causes and assists in development of strategies to avoid future claim edits and denials
• Provides education to revenue cycle team and attends monthly billing staff meetings as appropriate
• Pursues ongoing professional growth and development to maintain coding certification while remaining current on all coding and regulatory updates in addition to participating in educational activities

Job Summary

JOB TYPE

Temporary

SALARY

$70k-89k (estimate)

POST DATE

05/14/2023

EXPIRATION DATE

06/20/2024