|Location:||Grand Forks, North Dakota (58201)|
|Salary:||$26.64/ hr - $44.40/ hr|
|Job Type:||Full Time|
|Posted:||7 days ago|
Primary City/State:Surprise, Arizona
Department Name:Denial Recovery-Corp
Job Category:Revenue Cycle
Primary Location Salary Range:$26.64/hr - $44.40/hr, based on education & experience
In accordance with Colorado's EPEWA Equal Pay Transparency Rules.A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you're looking to leverage your abilities - you belong at Banner Health.
This Coding Denials Management Specialist remote position within a growing Healthcare organization that offers many opportunities for advancement and growth. If you're ready to change lives, including your own, we want to hear from you.
Our Remote Coders have flexible hours and are required to live in Arizona, Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming!Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
This position is responsible for providing support to the organization's responses to audit requests for patient medical records. These requests can come from multiple external payors/audits including the RAC (Recovery Audit Contractor) program, FIs (Fiscal Intermediaries), MACs (Medicare Administrative Contractors), etc. This position manages the retrieval of patient records from facilities across the system and ensures complete medical records are received on a timely basis by the payor/auditor, evaluating any coding related denials received and facilitating timely appeals process using either external or internal resources. Responsibilities also include entering and/or managing the data as appropriate in the tracking database; assisting in the evaluation of requests, denial trends and the success of the appeal process; recommending, developing and/or coordinating appropriate education to address coding and billing trends in order to prevent further claims denials.
1. Tracks and monitors all responses to external payors/auditors for patient medical record requests for the company. This includes managing the initial request as well as timely appeals. Acts as a liaison between facilities and the external requestor to ensure all medical record are complete and are received by the external requestor in a timely manner and within established due dates. Coordinates with external consultants to manage outside counsel involved in higher level appeals of RAC determinations.
2. Manages the denial management process for coding related denials, evaluating claims deemed inappropriately paid by the external payor/auditor and determining the need for appeal. Works with facility and applies relevant coding and billing guidelines to make the determination for appeal.
3. Assists in tracking, monitoring, and reporting RAC coding related recoupments and payments following appeals and the effectiveness of the appeal process including denial reporting. Identifies coding trends and the type of claims being reviewed by the external payors/auditors, the status and success of all appeals.
4. Assists with monitoring related resources and websites to identify current external payor/auditor strategies and focus areas and ensure that up-to-date strategies are in place at both a system and facility level. Suggests and coordinates focus areas for audits and education to address specific coding and billing regulations and prevent further claims denials.
5. Works independently under limited supervision. Makes independent judgments based on specialized knowledge. Holds system-wide responsibility for managing the company responses to external requests for patient medical records from payors/auditors and associate denials pertaining to coding related issues. Internal customers: company leadership, company's Compliance Committees, physicians and clinical staff. External customers: RACs, FIs, MACs, Medical Directors/payors/reviewers, contracted review agencies, other facilities/services, physician's offices.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Requires a level of education as normally demonstrated by a bachelor's degree in Health Information Management and current continuing education.
Requires Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Requires proficiency typically obtained with five or more years of health care coding experience. Must demonstrate a proficiency in hospital and/or multiple physician specialty coding as normally obtained through five years of current and progressively responsible coding experience. Must possess a thorough knowledge of ICD/DRG coding and/or CPT coding principles, and the recommended American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record and an extensive knowledge of all coding conventions and reimbursement guidelines, across all services lines, LCD/NCDs and MAC/FIs. Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines, and maintain confidentiality of all work information. Ability to research, interpret and develop recommendations. Excellent written and oral communication skills are required, as well as effective human relations and leadership skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.
Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, as well as common office software and the electronic medical records software.
Additional related education and/or experience preferred.