Outpatient Denial Coder

Managed Resources, Inc.; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading provider of medical coding support is seeking a Coding Denials Specialist. This role involves reviewing coding-related denials, applying payer guidelines, and ensuring compliance with coding standards. Ideal candidates will have extensive coding experience and relevant certifications.

Qualifications

• 3-5 years previous physician coding experience.
• Experience working claim edits and denials.

Responsibilities

• Reviewing and resolving coding-related denials.
• Interpreting and applying payer guidelines.
• Tracking and trending denial data.

Skills

Communication

Organizational Skills

Attention to Detail

Adaptability

Education

CPC

CCS-P

CCS

Tools

EPIC

Cerner

Next Gen

Allscripts

Job description

CodingAID, a division of Managed Resources Inc. is a nationwide leading provider of medical coding support, coding and compliance reviews, educational programs, recruitment, revenue cycle management, and many other managed healthcare solutions. We’re proud to have served healthcare organizations and medical groups for 30 years with proven success in meeting their operational challenges.

Purpose:The Coding Denials Specialist will be responsible for: reviewing and resolving coding-related denials; interpreting and applying payer guidelines; tracking and trending denial data to help prevent future denials and identify trends with specific payers; and more

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:

• Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue
• Proficient in working denials for multispecialty coding, along with E&M coding for all places of services
• Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting
• Research as required any updates, and regulatory compliance
• Accurately code conditions and procedures as documented and in accordance with official coding guidelines established for use with mandated standard code sets
• Reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines
• Performs other Coding functions as appropriate, including assisting with coding backlogs as necessary
• Performs other duties as assigned

Ideal candidate will possess the following:

• Must hold the following credential: CPC, CCS-P, or CCS
• A minimum of (3-5) years previous physician coding experience with experience working claim edits and denials
• 3-5 years ICD-10 and CPT coding experience
• Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue
• Experience creating appeal letters as appropriate and communication with billing teams within Guide house or within a client organization
• Must have experience working in systems such as EPIC, Cerner, Next Gen, Allscripts or other EHR
• Excellent verbal and written communication skills
• Ability to interact with management personnel
• Possess strong organizational skills and attention to detail
• Adaptive and flexible to new ideas and change
• Ability to work in a changing environment
• Participate in special projects as needed

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