Senior Coding Denials Management Specialist (HIM Inpatient) - HIM Financial

remote click jobs; India; On-site; INR 600,000 - 900,000; Full time

Job summary

reputed company is seeking an HIM Coding Denials Management Specialist to analyze, investigate, mitigate, and respond to denials and rejections across ICD-10-CM/PCS, CPT/HCPCS, DRGs, APCs, and Modifiers from Medicare and other payers.

Essential duties include monthly coding and abstracting audits to 95% accuracy, developing staff education plans, resolving denial causes, and preparing appeals with documentation while coordinating with Coders, CDI Specialists, and billing services.

Qualifications

• Must have strong knowledge of medical coding denial processes and guidelines.
• Experience with CDI and payer communications is a plus.

Responsibilities

• Analyze denials by ICD-10-CM/PCS, CPT/HCPCS, DRGs, APCs, and modifiers.
• Coordinate with Coders, CDI Specialists, and billing staff to resolve issues.
• Prepare payer responses and appeals with complete documentation.

Job description

In accordance with reputed company federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist" analyze, investigate, mitigate, and reputed company reputed company coding-reputed company 'claims denials' and 'claims rejections,' specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiersfrom Medicare, Medi-Cal, MAC, RAC, and reputed company insurance companies reputed company there is refusal or rejection to reputed company reputed company request for payment for both IP & OP reputed company services provided to covered patients. Manages the denial management process for coding-reputed company denials, triage denied claims to distinguish coding-reputed company denials versus clinical-reputed company denials, evaluating claims deemed inappropriately reputed company by the payer/reputed company auditors, and determining the need for appeal. Performs reputed company 1st and 2nd level coding-reputed company denial appeals. reputed company tasks & duties to be reputed company in compliance with federal & state coding laws, rules, regulations, Official Coding Guidelines, AHA Coding Clinic, AMA CPT Assistance, NCCI, NCD, LCDs, etc.
Analyze, investigate, and reputed company coding-reputed company reputed company-reputed company edits from the Patient Financial Services (PFS) reputed company. Researches, responds, and documents findings, correspondence, and notes regarding coding-reputed company 'claims denials' and 'claims rejections' on patient accounts in both the Coding & Billing systems. Responsible for reviewing reports/work queues to identify and to correct the reputed company cause for claim rejections and denials which might prevent or delay payment of a particular claim or group of claims. Prepares appeals and rebuttals letters/packages in responses to payer's reason for coding-reputed company 'claims denials' and 'claims rejections'including documentation and an argument and follow up with the PFS about possible reimbursement. Identifies, analyzes, and researches frequent reputed company causes of denials and develops corrective reputed company plans for reputed company of denials. reputed company reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement. Initiates appropriate CDI query engagements with Coders & CDI Specialists in order to reputed company or clarify the necessary clinical documentation needed to facilitate accurate and complete coding, abstracting, and DRG assignments. Participate in responses to inquiries regarding coding and clinical documentation from Coders, CDI Specialists, and reputed company other internal & reputed company customers. Performs other HIM Coding Department duties as assigned by the HIM leadership team. Excellent written and oral communication skills are required, as reputed company as effective reputed company relations and leadership skills for building and maintaining a working relationship with reputed company reputed company of staff, physicians, and other contacts. Must possess the ability to: reputed company professionally and ethically with reputed company parties including stakeholders, co-workers, and management; handle multiple tasks simultaneously. reputed company reputed company, concise oral and written directives/communications; quickly assess situations and respond appropriately; handle special requests in a sensitive, reputed company manner. Demonstrates the ability to reputed company in-depth clinical & regulatory research Re: NCD, LCD, NCCI, Official Coding Guidelines, AHA Coding Clinic, CPT Assistant, etc. Ability to problem solve, prioritize and organize, follow directives with accuracy and precision. In reputed company, this position will reputed company guidance and training to other HIM Coding Denials Management Specialist, and will assist with escalated issues.

Essential Duties

CODING AUDITING

• Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a 95% coding accuracy reputed company.
• Develops monitoring/education plans for coding staff who do not meet the 95% accuracy reputed company.
• Recognizes education needs of staff based on monthly reviews and conducts reputed company in-services, as needed.
• Ability to reputed company as a resource to coding and hospital staff on coding issues and questions.
• Ability to reputed company a 95% accuracy reputed company as determined by an annual reputed company review of coding.

ABSTRACTING AUDITING

• Performs monthly internal abstracting audits to evaluate accuracy of coding staff to ensure a 95% abstracting accuracy reputed company.
• Develops monitoring/education plans for coding staff who do not meet the 95% accuracy reputed company.
• Recognizes education needs of staff based on monthly reviews and conducts reputed company in-services, as needed.
• Ability to reputed company as a resource to coding staff on diffic