Coding Denial Specialist (Remote)
Coding Denial Specialist (Remote)
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Job Description
Coding Denial Specialist (Remote)
Schedule:
Days: M-F. Full time 40hrs per week.
Work between 7am-6pm in your time zone. All US time zones are welcome to apply.
On occasion schedule adjustment may be necessary for mandatory department meetings/project-based meetings to accommodate all time zones.
Job Location Type:Remote
Your experience matters
At Lifepoint Health we are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team youll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier .
How youll contribute
Coding Denial Specialist performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referrals authorizations notifications non-coverage medical necessity and others as assigned. The Coding Denial Specialist conducts comprehensive reviews of the claim denial account/guarantor notes associated with the denial and the medical record to make determinations if a revised claim needs to be submitted if a written appeal is needed or if no action is needed. The Coding Denial Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation third-party payer medical policies and contract language. Appeals are submitted timely and tracked through outcome. The incumbent will also handle audit-related / compliance responsibilities and other administrative duties as required.
A Coding Denial Specialistwho excels in this role:
- Certified Pro-Fee with a minimum of 3-5 years coding experience.
- Experience with Provider Based and Rural Health preferred.
- Manage time effectively to meet all required deadlines and timeframes for client and department needs.
- Collaborate in a team environment with the Department Manager and other staff on a regular basis.
- Ensure compliance with all relevant regulations standards and laws.
- Research payer denials related to referral pre-authorization notifications medical necessity non-covered services and billing resulting in denials and delays in payment.
- Independently write professional appeal letters.
- Submit detailed customized appeals to payers based on review of medical records and in accordance with Medicare Medicaid and third-party guidelines.
- Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
- Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root cause resolution.
- Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
- Claim corrections in a timely manner including portal corrections.
- Review payor communications identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders managed care contracting and Revenue Cycle leadership as appropriate.
- Identify opportunities for process improvement and actively participate in process improvement initiatives.
- Complete any coding and billing related denial as required by payer and system.
Why join us
We believe that investing in our employees is the first step to providing excellent patient addition to your base compensation this position also offers:
Comprehensive Benefits:Multiple levels of medical dental and vision coverage for full-time andpart-time employees.
Financial Protection & PTO:Life accident critical illness hospital indemnity insurance short- and long-term disability paid family leave and paid time off.
Financial & Career Growth:Higher education and certification tuition assistance loan assistance and 401(k) retirement package and company match.
Employee Well-being:Mental physical and financial wellness programs (free gym memberships virtual care appointments mental health services and discount programs).
Professional Development:Ongoing learning and career advancement opportunities.
Performance bonus eligible!
What were looking for
Education: High school diploma or equivalent required. Bachelors Degree preferred or equivalent experience
Experience: 3-5 years medical coding denial experience
Certifications: Coding Certification through AHIMA or AAPC. (CPC CEMC CPMA CRC CPB RCMS Specialty certification CCS-P RHIT)
EEOC Statement
Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
You must be authorized to work in the United States without employer sponsorship.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
