General Description The Medical Coding Specialist assists with:
Implementation, tracking and maintenance of claim coding denials to ensure optimal collections related to claims denied as a result of lack of medical necessity, inadequate ICD-10 coding or other clinical errors. Identification of denied claims and the initiation and coordination of the appeals process. Refiles denied claims with coding corrections after reviewing medical records and discussing with clinical team. Support the A/R Team and Appeals Specialist with Administrative tasks including appeal submission, tracking and payor follow-up as needed to maximize collections. Position will be 100% remote - Laptop provided Reports To : Director of Revenue Cycle
Hourly pay rate : $25 - $30
The following is a list of specific duties, which are considered to be essential functions of this job. The list is not exhaustive as all duties are subject to change. This is consistent with our need to be flexible and responsive to the needs of our customers, patients, co-workers and associated policies. The employee who occupies this position is expected to assume any/all duties assigned by management, irrespective of whether such duties are specifically included in this list. While an effort has been made to thoroughly describe the customary manner in which this job is performed, reasonable accommodation will be made upon notification for qualified individuals with disabilities who may not be able to perform the job in the manner indicated.
Identification of denials in billing clearing house, Waystar, that are the result of lack of medical necessity, inadequate ICD-10 coding or clinical error. Coordinates and tracks claim appeals for above referenced denied claims through all necessary levels of appeal. Follows up with payors as needed to ensure timely receipt of decision and timely appeal submission. Updates claims in denials management systems. Compiles document packets to assist Appeal Specialist with appeal preparation. Submits completed appeal packets to payor via payor portal/esMD/Waystar/Mail/Fax, etc. Compiles and submits medical review medical records submissions for payment. Updates claims in software to accurately reflect current status. Facilitates claim corrections, in coordination with SL RVP's and billing team. Assists with information gathering, compliance audits, data compilation & tracking tasks. Communicate professionally and effectively with all personnel to support the denials processes. Communicate effectively with public and external personnel as needed regarding payment denials and appeals. Establish and maintain HPH's commitment to exceptional customer service with company staff and fellow members of the HPH team, embracing and demonstrating our corporate philosophy. Assist with denials/appeals presentations and trainings. Prepare and submit reports to Management of progress and findings. All other duties as assigned, with potential for position to evolve. Knowledge, Skills and Experience Required :
Minimum two years of medical coding experience and working knowledge of billing regulations. Coding Certification not required. Minimum two years of medical billing experience required. Must have exceptional organization and communication skills, ability to prioritize, effectively communicate and execute timely, all tasks related to the denials/appeals process. Self-motivated and disciplined with the ability to work remotely. Must be knowledgeable of the interpretation of remittance advice from Medicare Administrative Contractors and other payors, and terminology related to denials. Must demonstrate the ability to manually enter information into therapy EMR and extract information as directed by QAC, RD, RVP. Fundamental working knowledge of denials and appeals process. Proficient knowledge in Microsoft office (word, excel), Adobe PDF, job-related internet research. Comfortable with computer and software utilization and expedient in grasping new software applications. Familiarity with medical terminology a plus including use of CPT and ICD-10 coding guidelines. Must be able to communicate effectively with internal and external customers; facility staff, HPH field management, corporate partners, etc.
