Processes and appeals claims denied for coding or medically necessary related reasons. Facilitates accurate coding by providing feedback related to payor denials and policies to coding personnel. This position involves reviewing the documentation to determine if the claim was submitted per CPT, ICD-10 coding guidelines, & the correct coding initiative. Researching and analyzing payor policies, and evaluation of reimbursement contracts to determine appropriate payment
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Provide/support coding reimbursement education to improve providers' coding accuracy and optimize collections.
Attend and/or conduct periodic coding / charge entry and training sessions as requested.
Perform trend analysis of coding and medical necessity related denials to conduct process improvements to eliminate/reduce denials
Review coding and medical necessity related denials to identify patterns for coder and/or provider education and charge edit creation.
Thoroughly and timely work follow up records related to coding and medical necessity denials in work queues as defined by policies and procedures.
Appeal denied claims and follow up until resolution.
Review and appeal payments received that are not paid at levels in accordance with payor contracts.
Read and interpret EOB's (Explanation of Benefits)
Present unresolved concerns to Supervisor for resolution immediately with related documentation.
Document account activity accurately and promptly during or immediately following each processed encounter.
Responsible for the accurate and timely submission of claims, denials, written appeals, and re-bills of insurance claims.
Responsible for the analysis and necessary corrections of patient accounts as it relates to coding and medical necessity to submit clean claims or written appeals.
EDUCATION AND SKILLS
High school diploma or equivalent required.
AHIMA (CCA, CCS, CCS-, or RHIT); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the relevant AAPC specialty-specific coding credentials preferred.
Minimum of three years' experience in medical billing and collections or coding.
Working knowledge of ICD-10, CPT, and HCPCS coding and Correct Coding Initiatives (CCI) required.
Knowledge of government, commercial, and third party insurance contract practices and claims processing procedures preferred.
Ability to interpret insurance medical policies and procedures.
Demonstrated excellent written and oral communication skills.
Experience working in a medical office setting required, with demonstrated understanding of standard insurance reimbursement methodologies.
Ability to educate providers and others regarding coding, documentation requirements, and other relevant processes preferred.
Knowledge of medical terminology and anatomy required.
Excellent organizational skills and attention to detail required.
Must have demonstrated competence with computer systems including electronic health records, and Microsoft Office Suite required.
The above information is intended to indicate the general nature and level of work required in this position. It is not designed to contain or be interpreted as a comprehensive description of all duties, responsibilities, and qualifications required of those assigned to this job.
We offer a competitive Total Rewards Program which includes insurance programs covering medical, dental, vision, life, long-term disability, generous time off, holidays, education reimbursement, and a 401(k) plan. Eligibility for benefits is dependent on factors such as position type and FTE. Contact your recruiter for more information.
Vancouver Clinic is proud to be an Equal Opportunity Employer. Vancouver Clinic does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, gender identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.