Denials Management Coding Specialist

Full time
United States
Hiring from: Anywhere

Title: Denials Management Coding Specialist

  • Location: United States, Virtual/Remote

  • Classifications: Remote Full-Time

  • AdventHealth Corporate

  • Work Hours/Shift: Full-Time, Monday Friday


Top Reasons to Work at AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

You Will Be Responsible For:

  • Thorough knowledge of medical terminology, anatomy & physiology and pathophysiology

  • Extensive understanding of Coding guidelines, CCI edits, CPT, HCPCS, ICD, UB-04 Revenue Codes, modifiers, billing, regulations and guidelines

  • Ability to read medical charts or dictation, understand services performed, and correlate those services to charges on the bill

  • Proficiency in Microsoft Suite applications specifically Excel, Word and Outlook

  • Strong critical thinking and problem-solving skills with ability to multi-task or reprioritize quickly

  • Technical proficiency within Patient Accounting system and applicable vendor technologies; position requires ability to navigate various modules within applicable technologies to perform account research

  • Self-starter with the ability to work under limited day-to-day oversight in a remote setting

  • Ability to educate others regarding coding guidelines

  • Ability to maintain required productivity and accuracy standards


What You Will Need:

  • High school diploma or equivalent

  • RHIA, RHIT, CPC, or CCS certification or credential

  • At least one year experience working payer denials for medical necessity, SSI and NCCI edits, incorrect procedure/diagnosis coding

  • At least five years recent acute care coding experience to include; Inpatient, ED, ancillary, observation, outpatient, and surgery coding.

  • Experience with HCPCS codes and resolution of OCE edits, SSI edits and CCI edits

  • Familiarity of the DRG reimbursement system

  • Medical Necessity and DRG appeal writing experience

  • Coding Audit experience

Job Summary:

The Denials Management Coding Specialist is responsible for investigating and resolving coding related denials from payers, preventing lost reimbursement and promoting denial prevention. The Denials Management Coding Specialist addresses both Inpatient and Outpatient claims and serves as a resource for all coding related questions and guidance to the Centralized Denial Team. The Denials Management Coding Specialist will adhere to the AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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