Coding Denials Manager
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Job Description
Coding Denials Manager at CorroHealth overseeing investigations and resolutions of insurance coding denials. Aiming to optimize reimbursement through timely actions and collaboration.
Responsibilities:
- Oversee the investigation and resolution of third-party insurance coding denials and edits for CorroHealth clients
- Assist in the supervision of optimizing reimbursement by thoroughly researching and taking timely, appropriate action to ensure resolution of all coding denials.
- Review and research coding denials that have been received as no payment/previous submitted claims with a denied or no response for payors and service areas
- Identify root cause of the coding denial, resubmit claim and address/report the denial issue to leadership
- Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews
- Obtain and review medical records through EMR, site request or hospital portals for reconsideration purposes
- Utilizes all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal denied claims
- Comply with adjustment and appeal or reconsideration in conjunction with each service area's Coding and Reimbursement guidelines
- Effectively utilizes ICD 10 CM and CPT codes and related material to investigate and ensure that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
- Organizes work/resources to accomplish objectives and meet timely filing deadlines
- Demonstrates problem-solving skills related to coding denial analysis
- Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively, to obtain necessary information to address denial issues
- Meets productivity requirements to ensure excellent service is provided to customers
- Adheres to compliance and corporate and departmental policies and procedures
- Identifies all coding denial trends and provide education of steps to prevent future avoidable denials
- Initiates and responds all coding appeals in a timely manner
- Logs and tracks all coding denial trends and coding denial increases on coding log
- Completes special projects as assigned by Director
- Maintains and utilizes accurate and current coding resource materials when making determinations for claim reconsiderations and appeals
- Performs other projects and duties as related to the overall organization's objectives
- Maintains confidentiality of all information as stipulated in the HIPAA Privacy Rules and Company Confidentiality Policy
- Maintain daily and monthly productivity goals – set depending on service area/payor assignment
Requirements:
- Must have a minimum of 3 years of coding experience preferably in profee surgeries, orthopedic, ophthalmology, neurology, trauma and more
- Must have a strong background in Revenue Cycle Management
- Requires strong computer skills, including Microsoft Office suite of products
- National certification through AAPC or AHIMA required
- MUST be certified through AHIMA (CCS, RHIT or RHIA)
- Must have advanced working knowledge and experience with systems such as various EMR, Billing, etc.
- Experience with Outlook, should be able to manage emails and schedule and attend meetings.
- Must have current coding materials such as CPT and ICD-10-CM coding references.
- Regular, predictable, and punctual attendance is required.
- Will be required to maintain an ongoing productivity level and accuracy rate of 95% or higher.
- Ability to communicate effectively and professionally both verbally and written.
- Ability to coordinate, analyze, observe, make decisions, and meet deadlines.
Benefits:
- Professional development opportunities
- Flexible working arrangements
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