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CommonSpirit Health · 21 hours ago

Denials Coder

Omaha, NE

Part-time

Onsite

Entry Level

$19.87/hr - $28.06/hr

1+ years exp

CommonSpirit Health is a healthcare organization that offers a range of services from primary to specialty care. They are seeking a Denials Coder responsible for resolving outstanding insurance balances related to coding denials through effective communication and analysis of medical records and claims.

Health CareMedicalNon Profit

Responsibilities

Under direct supervision, this position is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements

The incumbent conducts follow-up process activities through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently

Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals

Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies to bring timely resolution to issues that have a potential impact on revenues

In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution

Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received

Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements

Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal

Resubmits claims with necessary information when requested through paper or electronic methods

Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify

Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels

Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides

Assists with unusual, complex or escalated issues as necessary

Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc

Accurately documents patient accounts of all actions taken in billing system

Qualification

ICD-10 codingCPT codingInsurance follow upMedical terminologyAnalytical skillsAttention to detailEffective communication

Required

High School / GED: Required

Preferred

Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology

Completion of ICD-10 or CPT coding Course

1+ years coding experience

Insurance follow up experience

Company

CommonSpirit Health

Glassdoor3.6

Common Spirit Health is a healthcare organization that provides research programs, home health programs, and virtual care services. It is a sub-organization of CommonSpirit Health.

Founded in 2019

Chicago, Illinois, USA

10001+ employees