The Multispecialty Denials Coding Specialist will review documentation and coding guidelines for profession fee-based coding, evaluation and management services, procedures, and diagnoses. Researching claim denials, submitting appeals, following up on outstanding claims, and handling claims correspondence. This is a PRN/part-time employee opportunity.
Essential Job duties and Responsibilities:
- Research payer denials related to referral, pre-authorization, eligibility/registration, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
- Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as client’s policies and procedures.
- Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
- Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment.
- Ensure appropriate revenue is captured; to prevent federal and payer audits, malpractice litigation, and health plan denials.
Requirements:
- Profee multispecialty, E/M coding: 3 years
- Physician based Denials: 3 years
- (AAPC) CPC and/or (AHIMA) CCS, CCS-P, or RHIT.
- Knowledge of medical terminology, insurance and appeals processes, and medical record management.
- High level of accuracy and attention to detail
- Strong written and verbal communication skills.
- Proficiency with MS Office Suite and Athena software.