Coding Denial Reimbursement Analyst - Contract
Job Summary:
The Coding Denial Reimbursement Analyst demonstrates the ability to locate, research, comprehend and appropriately apply 3rd party payer rules and regulations to resolve complex coding related claim denials in a manner that ensures accurate and optimal reimbursement.(This is an estimated 4 to 6 month contract, dependent upon the needs of the RCM team)
Primary Job Responsibilities:
- Root cause claim denials and offer recommendation for prevention. Report high volume coding denial trends to the coordinator
- Reviews, researches, resolves and trends billing and coding edits for specific specialties
- Maintain current knowledge of coding, compliance, and documentation guidelines
- Resolve claim holds, CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
- Resolve coding denials through claim correction or appeal. Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications.
- Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published coding guidelines published by the AMA
- Provide coding guidance to providers and charge entry staff for single or low volume errors.
- Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations
- Maintain a comprehensive payor and managed care intelligence database; to source research and analysis as needed
- Review TMP encounters on hold to verify the documentation supports all required billing and documentation components.
- Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations
- Additional duties as assigned
Requirements:
- High school diploma required. Associate or bachelor’s degree preferred. Two (2) years of revenue cycle experience may be considered in lieu of degree.
- Proficient in Microsoft Office and billing software applications.
- Thorough understanding of ICD10-CM, CPT, and Local and National Correct Coding Initiative policies.
- Demonstrates clear and concise oral and written communication skills.
- Demonstrates strong decision making and problem-solving skills.
- Personal initiative to keep abreast of new developments in coding updates/technology/research/regulatory data.
- Detail oriented and ability to meet deadlines.
- Ability to adjust successfully to changing priorities and workload volume. Knowledge of medical terminology, ICD-10, and CPT codes
- Excellent verbal communication skills
- Intermediate skill level with Microsoft Word, Outlook, and Excel.
- Experience interpreting payor policies and explanation of benefits.
Education and Certifications:
- CPC-A, CPC, or RHIT certification required.
Experience:
- Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies.
- Experience working within EMR systems.
- Minimum 2 years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
- Experience with Athenahealth EMR is a plus.
- Ability to manage time and organize daily schedule to meet productivity and accuracy standards with minimal supervision.
Physical Requirements:
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds.
- Ability to concentrate on details.
- Use of computer for long periods of time.
