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Denials Management Coder in Altamonte Springs, FL at AdventHealth

Date Posted: 4/9/2019

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Health Information Management
  • Travel
    Yes, 25 % of the Time
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description


Denials Management Coder AdventHealth Corporate

Location Address: 900 Hope Way Altamonte Springs, Florida 32714

Top Reasons To Work At AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential
Work Hours/Shift:
  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Reviews and resolve accounts assigned via work list daily as directed by management. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, reviewing documentation to determine appropriate course of appeal if applicable.
  • Collaborates with physicians and nurses to obtain further patient information be used in the appeals process and provide reports, education, and training on identified coding denial trends and recommended remediation.
  • Assists in Medicare Recovery Audit Contractor (RAC) denials and processes each denial following the established framework; assistance with additional audits may be required
  • Recommends or educates others on policies regarding the proper use of CPT Codes, modifiers, and diagnosis codes in order to comply with regulations set forth by the Center for Medicare & Medicare Services (CMS), managed care payers, PPO contracts, indemnity insurers, and all other healthcare payers. This may include distribution of guidelines to providers.
  • Defends and appeals denied claims, including researching underlying root cause, collecting required information or documents, and, adjusting the account as necessary to ensure adjudication of the claim. Is comfortable communicating denial root cause and resolution to leadership as needed.

What You Will Need:
  • High school diploma or equivalent
  • Current Medical Coder Certification
  • Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook
  • Technical proficiency within Patient Accounting system and applicable vendor technologies; position requires ability to navigate various modules within applicable technologies to perform account research
  • Extensive understanding of CCI edits, CPT, HCPCS, ICD, UB-04 Revenue Codes, modifiers, billing, regulations and guideline

Job Summary:


Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. This position is responsible for investigating and resolving coding related denials from third party payers in an effort to prevent lost reimbursement. The position will require experience in coding and revenue integrity, with a focus on researching and appealing denials related to bundling/unbundling, DRGs, medical necessity, among other issues. The ability to effectively communicate with third party payer representatives and knowledge of appeal guidelines will be vital to the role. The representative will serve as a resource for all coding related questions and guidance on working coding denials and will utilize the appropriate tools to communicate with other departments regarding any necessary updates to ensure accurate and timely claim adjudication. They will adhere to the AHS 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.

Location | Organization | Category | Job Function