AdventHealth Denials Management Coding Specialist in Miami, Florida
Denials Management Coding Specialist
Location Address: 2600 Lucien Way, Maitland, FL 32751
Top Reasons to Work at AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
- 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
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.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.