Coding Denial Specialist

Job Summary

The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution. 

Essential Functions And Tasks

•    Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques. 
•    Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides. 
•    Validate denial reasons and ensures coding is accurate. 
•    Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. 
•    Follow specific payer guidelines for appeals submission. 
•    Escalate exhausted appeal efforts for resolution. 
•    Adhere to departmental production and quality standards. 
•    Complete special projects as assigned by management. 
•    Maintain working knowledge of workflow, systems, and tools used in the department. 

Education And Experience Requirements

•    High school diploma or equivalent. 
•    One to three years’ experience in physician medical billing with emphasis on research and claim denials. 

Knowledge, Skills, And Abilities

•    Knowledge of health insurance, including coding. 
•    Thorough knowledge of physician billing policies and procedures. 
•    Thorough knowledge of healthcare reimbursement guidelines. 
•    Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. 
•    Computer literate, working knowledge of Excel helpful. 
•    Able to work in a fast-paced environment. 
•    Good organizational and analytical skills. 
•    Ability to work independently. 
•    Ability to communicate effectively and efficiently. Proficient computer skills, with the ability to learn applicable internal systems. Ability to work collaboratively with others toward the accomplishment of shared goals. 
•    Basic use of computer, telephone, internet, copier, fax, and scanner. 
•    Basic touch 10 key skills. 
•    Basic Math skills. 
•    Understand and comply with company policies and procedures. 
•    Strong oral, written, and interpersonal communication skills. 
•    Strong time management and organizational skills. 
•    Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. 

Interested profiles kindly drop your resume to this Email Id jonathanjoel.wilsonchurchilprabu@ventrahealth.com