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Denials And Appeals Specialist II (Remote Medical Coding)
Job Description
POSITION SUMMARY Reviews and responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Reviews denial trends and identifies coding issues and knowledge gaps. Collaborates on operational performance and department quality improvement activates and committees. RESPONSIBILITIES
- * Liaise between the RAC, commercial payers, managed care and third party review organizations.
- Manages timely review, investigation and response to coding denials.
- Establish denial reviews and response processes.
- Prioritizes and reviews cases denied by commercial payers.
- Determines actions required for appeals within contractual timeframes.
- Reports program performance and/or corrective action to management on regular basis.
- Monitors inpatient denial types, volume and formulates responses to requesting agency. Seeks additional resources (e.g. legal counsel) to resolve issues, as needed.
- Develops case-specific written rationale to substantiate and communicate findings.
- Reviews denial trends and identifies coding issues and knowledge gaps.
- Functions as a Health System resource for litigation as related to coding denials.
- Maintains Greater NY Hospital Association database.
- Functions as the Health System’s resource for the tracking system for government appeals.
- Remains up-to-date on DRG system literature from all agencies.
- Knowledge, understanding of Federal and NYS DRG’s.
- Maintains coding clinic up-dates.
- Performs related duties, as required.
- ADA Essential Functions
REQUIRED EXPERIENCE AND QUALIFICATIONS
- Bachelor’s Degree in Health Information Management or related field, preferred.
- Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
- RHIA, RHIT or RN, CCS, required.
- Strong written, communication, presentation and organizational skills, required.
Qualifications
REQUIRED EXPERIENCE AND QUALIFICATIONS
- Bachelor’s Degree in Health Information Management or related field, preferred.
- Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
- RHIA, RHIT or RN, CCS, required.
- Strong written, communication, presentation and organizational skills, required.
- Denials and appeals review strongly preferred.
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