Profee Medical Coding Denial Specialist

TheCoding Denial Specialistwill reviewassigned coding denialsacrossmultiple specialties, determine root cause and followingestablished clientworkflowresolveand/or appeal denialsbased onclinical documentation and diagnostic resultsin alignment withFederal & State Coding regulations;including the National Correct Coding Initiative, CPT, HCPC’s and ICD10 CM GuidelinesThis position is full time and is 100% remote.

• Triage incoming coding denial inventory, validating appeal criteria is met in compliance with departmental policies and procedures 

• Compose technical denial arguments for reconsideration and appeal 

• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument 

• Identify problem accounts/processes/trends and escalate as appropriate 

• Utilize effective documentation standards that support a strong historical record of actions taken on the account 

• Resolve claims impacted by payor recoupments, refunds, and posting errors 

• Assist team members with coding questions and provide resolution guidance 

• Meet and maintain established performance metrics for production and quality  

• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing 

• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. 

• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. 

• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. 

• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. 

• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. 

• Responsible for coding or pending every chart placed in their queue within 24 hours. 

• It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. 

• Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. 

• Coders must maintain their current professional credentials while working for Guidehouse. 

• Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. 

• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) 

• It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content. 

• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.