Coding Denials Specialist (EM IP Coding)

Overview

• The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution.

Responsibilities

• Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques.
• Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides.
• Validate denial reasons and ensures coding is accurate.
• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
• Follow specific payer guidelines for appeals submission.
• Escalate exhausted appeal efforts for resolution.
• Adhere to departmental production and quality standards.
• Complete special projects as assigned by management.
• Maintain working knowledge of workflow, systems, and tools used in the department.

Qualifications

• High school diploma or equivalent.
• One to three years’ experience in physician medical billing with emphasis on research and claim denials.
• Current AAPC or AHIMA certification required.