Hiring Radiology Denial Coder - Chennai Location

Ventra Health, Inc.; Chennai; On-site; INR 450,000 - 800,000; Full time

Job summary

Ventra Health, Inc. seeks a denial management specialist to process accounts meeting coding denial criteria, resolve work queues, and validate reasons. You will generate appeals per payor terms, follow payer guidelines, escalate when needed, and maintain knowledge of systems. Fast-paced environment; strong communication and teamwork emphasized.

Applicants should have health insurance knowledge and proficiency in Excel; experience with ICD-10-CM/CPT coding is a plus.

Qualifications

• Knowledge of health insurance and coding is required.
• Familiar with physician billing policies and healthcare reimbursement guidelines.
• Proficient with AHA Official Coding and Reporting Guidelines, ICD-10-CM and CPT.
• Strong computer skills; Excel is helpful.
• Ability to work in a fast-paced environment and manage time effectively.
• Excellent organizational and analytical abilities; strong communication.

Responsibilities

• Processes accounts that meet denial management criteria including rejections, down codes, bundling issues, modifiers, level of service and other queries.
• Resolve work queues according to priority and management direction per policies and aids.
• Validate denial reasons and ensure coding accuracy.
• Generate appeals based on dispute reasons and contract terms per payor guidelines.
• 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.

Skills

Health insurance knowledge

Physician billing policies

Healthcare reimbursement guidelines

AHA Coding & Reporting Guidelines

ICD-10-CM & CPT coding

Excel knowledge

Outlook

Word

Analytical skills

Time management

Tools

Excel pivot tables

Database software

Job description

Role & responsibilities

• 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.

Preferred candidate profile

• 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.