Denials Management Coding Specialist at AdventHealth

Date Posted: 8/9/2019

Job Snapshot

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

Job Description

Denials Management Coding Specialist 

AdventHealth Corporate 

Location Address: 2600 Lucien Way, Maitland, FL 32751

Top Reasons to Work at AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential
  • Faith-based environment

Work Hours/Shift:

  • Full-Time, Monday – Friday-Remote work from home opportunity available 

If you have a passion for coding and would like to work on a Centralized Denials Team, then we have the job for you!

  • Investigating and resolving coding related denials from payers on Inpatient, Outpatient, and ED post-remit claims
  • Reviewing and correcting coding for rebilling as needed
  • Conducting account history research, navigating patient electronic medical records and reviewing documentation to determine the appropriate course of appeal
  • Collaborating with clinical staff and/or outside providers to obtain further information to be used in the coding and appeals process
  • Evaluating coding denials to determine root causes and creating processes for denial prevention and avoidance 
  • Providing education and training on identified coding denial trends and recommended remediation
  • Creating written appeals utilizing official coding guidelines, coding clinic, and CPT assistant or other resources as appropriate 
  • Assisting with payer audits as required

What You Will Need:

  • High school diploma or equivalent
  • At least five years recent acute care coding experience to include Inpatient, ED, ancillary, observation, outpatient and surgery coding.
  • Current RHIA, RHIT, or CCS certification or credential
  • 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 a plus
  • Knowledge of NCD/LCD coverage policies

Job Summary:

Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. The Denials Management Coding Specialist is responsible for investigating and resolving coding related denials from payers and promoting denial prevention.  The Denials Management Coding Specialist addresses both Inpatient and Outpatient claims and serves as a resource for coding related questions and guidance to the Centralized Denial Team.  The Denials Management Coding Specialist 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.

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