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HCA Healthcare · 1 day ago

Clinical Denial Coding Review Specialist

Plano, TX

Full-time

Onsite

Entry, Mid Level

2+ years exp

HCA Healthcare is a leading provider of healthcare services, and they are seeking a Clinical Denial Coding Review Specialist to join their team. This role involves applying correct coding guidelines to research, analyze, and resolve clinical denials and insurance claims, while maintaining communication with payors and practices.

BiotechnologyHealth CareHospitalMedicalPrimary and Urgent Care

Responsibilities

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

Maintain working knowledge of workflow, systems, and tools used in the department

Qualification

Coding certificationInsurance follow-upAccounts receivable experienceEOB interpretationAnalytical skillsCommunication skillsProblem-solving skills

Required

Prior experience reading and interpreting Explanation of Benefits (EOB) required

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

Coding certification through AHIMA or AAPC strongly preferred

Benefits

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.

Company

HCA Healthcare

Glassdoor3.3

HCA Healthcare provides medical education and healthcare services in locally managed facilities. It is a sub-organization of North Florida Endoscopy Center.

Founded in 1968

Nashville, Tennessee, USA

10001+ employees