Edits & Denials Coder

Insight Global; United States; Sur place; USD 55 000 - 75 000; Plein temps

Résumé du poste

Insight Global seeks an Edit & Denials Coder to review medical records and assign proper billing codes, perform advanced coding and appeal activities, and handle payer issues with timely filing of appeals.

This role involves researching payer policies, correcting coding edits, and coordinating with clinical staff to ensure accurate documentation for claims processing.

Qualifications

• 5 years minimum Edit & Denials coding experience.
• Experience coding for professional and facility coding.
• Ability to operate across multiple clients.
• Experience making changes in EHR systems.
• Experience reviewing and correcting coding edits.
• Strong communication and collaboration skills.

Responsabilités

• Review documentation to identify facts for appealing denied claims or holds.
• Meet with facility liaison to review documentation, resolve coding, and tag files for follow-up; develop appeals.
• Research payer policies and processes.
• Review clinical documentation to ensure comprehensive diagnoses and procedures.
• Manage work queues, review remittance advice, and identify rejected invoices or claims.

Connaissances

Edit & Denials coding

Professional coding

Facility coding

Multi-client experience

EHR changes

Reviewing coding edits

Communication skills

Description du poste

Required Skills & Experience

• 5 years minimum of Edit & Denials coding
• Professional and facility coding.
• Ability to operate across multiple clients.
• Experience making changes in EHR systems
• Experience reviewing and correcting coding edits.
• Strong communication and collaboration skills.

Job Description

We 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.