Remote Retrospective Appeal Coding Specialist

UPMC; United States; À distance; USD 65 000 - 90 000; Plein temps

Résumé du poste

UPMC Corporate Revenue Cycle is seeking a Retrospective Appeal Coder to join our team. This remote role operates Monday through Friday.

The coder will initiate retrospective appeals for coding denials, leveraging payor regulations and a coding knowledge base to recover denied reimbursements. This position requires collaboration with coding and payor departments and ongoing education on the appeal process.

Responsabilités

• Assist in determining system-wide coding needs through investigation of retrospective denials and identification of root cause. Review and resolve pre-bill edits as needed
• Maintain current knowledge of regulatory guidelines related to retrospective appeals.
• Serve as a liaison between coding and payors and facilitates payor/physician contact when indicated.
• Maintain collaborative relationships with coding management and appeal departments at payor organizations.
• Collaborate with other departments to ensure all information to support retrospective appeal is identified.
• Formulate written appeal letter as appropriate incorporating supportive documentation. (i.e. medical criteria, state regulations, etc).
• Perform coding review for cases referred for retrospective appeal/audits to determine if appeal is warranted.
• Act as liaison to other departments relative to the retrospective appeal process.
• Provide ongoing education to coding and other departments related to the appeal process.
• Ensure the appeal process is followed in order to accomplish timely and appropriate appeals.
• Identify and assign a root cause to each case to ensure denial reasons are tracked.
• Monitor and evaluate for areas of process improvement related to the retrospective appeal process.

Description du poste

UPMC Corporate Revenue Cycle is seeking a Retrospective Appeal Coder to join our team. This remote role operates Monday through Friday.

The coder will initiate retrospective appeals for coding denials, leveraging payor regulations and a coding knowledge base to recover denied reimbursements. This position requires collaboration with coding and payor departments and ongoing education on the appeal process.