Edits & Denials Coder

Insight Global; Brentwood (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Insight Global is seeking an Edit & Denials Coder to review medical records and determine appropriate billing codes and necessary documentation. The role involves advanced coding and appeal activities, investigating payer issues, and timely filing of appeals to insurance companies.

The candidate should have at least 5 years of experience in edit and denials coding across professional and facility settings, with proficiency in EHR systems and payor policies.

Qualifications

• 5 years minimum of Edit & Denials coding experience.
• Professional and facility coding experience.
• Experience making changes in EHR systems.
• Experience reviewing and correcting coding edits.

Responsibilities

• Review medical records to identify facts for appealing denied claims.
• Create letters to substantiate claim validity.
• Collaborate with facility liaison to review documentation and tag files for follow-up.
• Investigate payer issues with coding staff and faculty.
• Develop appeals with clinical staff for documentation feedback.
• Research payer policies and processes.
• Review clinical documentation to select appropriate diagnoses and procedures.
• Manage work queues and verify remittance advice for rejections and payment accuracy.
• Identify invoices or claims denied per billing edits.

Skills

Edit & Denials coding

Facility coding

EHR systems

Coding edits review

Cross-client ability

Tools

Billing software

Job description

Edit & Denials CoderRequired Skills & Experience- 5 years minimum of Edit & Denials codingProfessional and facility coding.Ability to operate across multiple clients.Experience making changes in EHR systemsExperience reviewing and correcting coding edits.Strong communication and collaboration skills.Job DescriptionWe are seeking an Edit & Denials Coder to review medical records to determine appropriate billing codes and necessary documentation. This role is responsible for performing advanced coding and appeal activities; investigating payer issues, completing charge corrections, and for timely filing of appeals to insurance companies.

Key Responsibilities:

• Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse.
• Creates appropriate letters to substantiate the validity of claims.
• Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up.
• Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty.
• Works directly with facility liaison or other clinical staff as needed to provide documentation feedback and to develop appeals.
• Researches payer policies and processes.
• Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment.
• Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed.
• Identifies invoices or claims that have been rejected per billing edits/criteria.