Denials and Appeals Coder

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What we Offer

• Career Growth Opportunities
• A Culture anchored in a strong sense of belonging
• Benefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment
• 401k (Discretionary match)
• Generous PTO
• 8 Paid Holidays
• Equipment Provided for Remote Roles

Overview

The Denials and Appeals Coder is responsible for reviewing various carrier denials for their assigned billing groups. Submit corrections as needed after review of the notes in the medical records and apply TeamHealth’s coding policies, and/or carrier policies according to the rejection(s) posted. Maintains accuracy and production to ensure invoices are processed timely and efficiently.

Essentials Duties and Responsibilities

• Work invoices daily to maintain view age at the required department standard
• Work cross-workflow, claim edits and No Activity daily through ETM
• Apply extensive knowledge of ICD-10 and CPT guidelines
• Apply TeamHealth coding policies but acknowledging payer policy guidelines may differ due to payer updates, etc.
• Utilize LMRPs, LCDs and NCDs via multiple websites such as CMS or the local MAC as needed for denials
• Report any payer problems, policy changes or denial patterns found to the Denials and Appeals Senior and Supervisor so that it can be researched
• Review any claim processing problems found such as invalid NPI’s, invalid providers, TES Edit, and claim edit problems
• Maintain QA standards of 5% or below, including the annual Level 3 QA assessment
• Maintain required set production for denials and appeals
• Maintain all personal EMR login list by logging in once a month and reporting any login problems or unused logins to management
• Works with other departments to resolve Coding Rejections along with any other problems found
• Perform production coding as needed, including one day during closing
• Assist the Supervisor and Senior with any duties that need completed

Qualifications / Experience

• High school diploma or equivalent required. College course work preferred in a healthcare related field. Additional training in coding and medical documentation required
• Extensive knowledge of medical terminology, regulatory requirements and physician billing
• Record of passing Level 2 QA audits
• Proficiency in ICD-10 coding and CPT procedural coding
• CPC, RHIT or CCS-P certification preferred
• Minimum two (2) years medical coding experience
• Excellent organizational, analytical and communication skills
• Maintain confidentiality at all times