Denials Coder

CHI; Omaha (NE); On-site; USD 28,000 - 39,000; Full time

Job summary

CHI Health Clinic is seeking a Medical Coder to ensure precise communication with insurance companies so services are documented correctly and payments are processed efficiently.

Every day you will translate patients’ medical records into ICD-10 and CPT codes, maintain compliant documentation, and apply coding standards and regulations.

The role emphasizes detailed chart reviews, interaction with providers, and timely resubmissions and appeals to optimize outcomes.

Qualifications

• High School Graduate General Studies and 1+ years coding experience, upon hire
• High School GED Generals Studies and 1+ years coding experience, upon hire
• Associates Other in related field and Insurance follow up experience, upon hire
• Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology., upon hire
• Completion of ICD-10 or CPT coding course., upon hire
• Certified Professional Coder, upon hire or
• Certified Professional Coder Hospital Apprentice, upon hire or
• Certified Professional Coder Apprentice, upon hire or
• Certified Coding Associate, upon hire or
• Cardiology Coding, upon hire or
• Certified Coding Specialist, upon hire or
• Certified Coding Specialist - Physician Based, upon hire or
• Certified Cardiovascular and Thoracic Surgery Coder, upon hire or
• Certified Health Care Compliance, upon hire or
• Certified Interventional Radiology Cardio Coder, upon hire or
• Certified Professional Coder Hospital, upon hire or
• Radiology Certified Coder, upon hire or
• Registered Health Information Administrator, upon hire or
• Registered Health Information Technician, upon hire

Responsibilities

• Applies a thorough understanding/interpretation of EOBs and remittance advice to ensure correct payment
• Communicates with providers to explain balance outstanding, denied or underpaid using EOB-based reasoning
• Review patient medical records, change coding based on documentation to include diagnosis codes, modifiers, place of service
• Resubmits claims with necessary information when requested
• Identifies trends and conducts staff training to address issues
• Escalates issues through defined channels when assistance is needed

Skills

Attention to detail

Communication skills

Medical coding experience

Education

High School Diploma

CDI/Coder certification

Certified Professional Coder

Certified Professional Coder Hospital Apprentice

Certified Coding Specialist

Certified Coding Specialist - Physician Based

Radiology Certified Coder

Registered Health Information Administrator

Registered Health Information Technician

Job description

Job Summary And Responsibilities

As a Medical Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently.

Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards.

To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time.

• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
• Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

Job Requirements

Preferred

• High School Graduate General Studies and 1+ years coding experience, upon hire or
• High School GED Generals Studies and 1+ years coding experience, upon hire and
• Associates Other in related field and Insurance follow up experience, upon hire and
• Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology., upon hire and
• Completion of ICD-10 or CPT coding course., upon hire
• Certified Professional Coder, upon hire or
• Certified Professional Coder Hospital Apprentice, upon hire or
• Certified Professional Coder Apprentice, upon hire or
• Certified Coding Associate, upon hire or
• Cardiology Coding, upon hire or
• Certified Coding Specialist, upon hire or
• Certified Coding Specialist - Physician Based, upon hire or
• Certified Cardiovascular and Thoracic Surgery Coder, upon hire or
• Certified Health Care Compliance, upon hire or
• Certified Interventional Radiology Cardio Coder, upon hire or
• Certified Professional Coder Hospital, upon hire or
• Radiology Certified Coder, upon hire or
• Registered Health Information Administrator, upon hire or
• Registered Health Information Technician, upon hire

Where You'll Work

From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Pay Range

$19.87 - $28.06 /hour