Denial Coding Review Specialist

Introduction

Do you want to join an organization that invests in you as a Denial Coding Review Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Denial Coding Review Specialist like you to be a part of our team.

Job Summary and Qualifications

As aDenials Coding Review Specialist,you willberesponsible forapplying correct coding guidelines and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims.

What you will do in this role:

• Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures
• Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate
• Compose technical denial arguments for reconsideration, including both written and telephonically
• 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
• Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information
• Update patient accounts as appropriate
• Submit uncollectible claims for adjustment timely and correctly
• Resolve claims impacted by payor recoupments, refunds, and posting errors
• Assist team members with coding questions and provide resolution guidance
• Provide coding guidance and support to Practices
• Meet and maintain established departmental performance metrics for production and quality

What qualifications you will need:

• High school diploma or GED preferred
• Minimum two years related experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical/billing, medical payment posting, and/or cash application.
• Prior experience reading and interpreting Explanation of Benefits (EOB) required
• Coding certification through AHIMA or AAPC preferred

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Parallonprovides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

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"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Denial Coding Review Specialist opening. Qualified candidates will be contacted for interviews.Submit your resume today to join our community of caring!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.