Denials Management Coder in Altamonte Springs, FL at Adventist Health System

Date Posted: 11/9/2018

Job Snapshot

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

Job Description

Work Hours/Shift

Full Time, Monday-Friday

Adventist Health System Corporate Office

Be part of the Adventist Health System family.

Where you work matters. Working here is like being part of a family. Not just with those you serve, but also with your team members. It’s about making a difference, saving lives, and helping others live a fuller one. You’ll be joining a family of tens of thousands of team members who understand that what they do is bigger than healthcare. It is living out our mission to Extend the Healing Ministry of Christ and being there for someone every step of the way-body, mind, and spirit.

This is more than a career. It is a calling.

With hospitals and facilities in 9 states, you’ll have endless opportunities to take your talents, develop your skills, and grow as a professional in a place that truly cares about your success. If you are driven, compassionate, someone who always wants to go above and beyond because you care and believe what you do makes a difference – Adventist Health System is for you.

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.

What 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.
  • Escalates any discrepancies and issues encountered to supervisors in a timely manner. Collaborates with appropriate AHS departments and staff (e.g. patient access, clinical, patient financial services) when additional information or expertise is requested/required for accurate claim adjudication. Keeps up to date on department and organization policies and payer regulations.
  • Participates in denials management committees and provides updates on coding related denials trends, issues and remediation plans as needed.
  • Strives towards meeting and exceeding productivity and quality expectations to align performance with assigned roles and responsibilities. Escalates concerns or difficulties in meeting performance expectations in a timely manner for management action.
  • Maintains a positive working relationship with internal staff and external providers, payer representatives and patients and acts in a professional, courteous manner at all times.
  • Performs other duties as assigned by management.
What you will need:
  • High school diploma or equivalent
  • Current Medical Coder Certification
  • Extensive understanding of CCI edits, CPT, HCPCS, ICD, UB-04 Revenue Codes, modifiers, billing, regulations and guidelines

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