PB RI Denials Spec / PB Coding

Position Summary: The PB Revenue Integrity Denials Specialist is responsible for review and research of professional coding denials and identification of root causes for resolution to improve timely revenue recovery. Utilizes expert problem-solving skills to resolve complex billing issues, unpaid claims and customer complaints, taking all steps and coordinating corrective action to ensure full resolution of prompt payment.

Position Responsibilities: Key Areas of Responsibility Work key workques related to Coding denials and Customer Service Complaints Review and research Customer Service Coding Complaints and bring to resolution Review and research coding denials related to medical necessity, Coding and identify root causes for resolution Review Medical records for reconsideration purposes Evaluates denials against medical record documentation, the coding of the encounter, payer policies to determine if coding corrections are needed or the denial can be appealed Analyzes medical records, interprets documentation and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD?10?CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software encoder, coding manuals and other reference material as required. Demonstrates in-depth understanding of Medicare, Medicaid and private payors, policies and guidelines Researches and resolves denials making appropriate decisions on accounts to optimize reimbursement Accurately document all account activity in Epic. Adheres to all department coding/charging procedures, policies, guidelines and quality standards. Assists manager with special projects/other tasks as assigned Abides by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adheres to official coding guidelines. Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards). Proactively identifies opportunities for revenue cycle improvement initiatives to prevent future denials/Avoidable Write offs (AWOs) and improve timely revenue recovery. Collaborate with leadership and other key stakeholders to make solution recommendations. Examples include but not limited to Education for clinicians and or coders or new EPIC edits to prevent denials. Maintains appropriate Standard Work documentation related to denials & customer service work As assigned, assists in training new colleagues to become acclimated to the environment and in understanding internal policies and procedures, and documentation guidelines. QualificationsEducation Associates degree or equivalent work experience Experience 3-5 years of experience with professional Coding denial/avoidable write-off (or healthcare experience) Licensure, Certification, Registration CPC, CCS-P certification required and maintained thereafter

Language Skills: Strong written and verbal communication skills. Knowledge, Skills and Ability Requirements: Strong knowledge of coding concepts