Retrospective Appeals Coder

UPMC; Pittsburgh (Allegheny County); Remote; USD 60,000 - 85,000; Full time

Job summary

UPMC Corporate Revenue Cycle is seeking a Retrospective Appeal Coder who will work remotely from Monday to Friday. The role focuses on initiating retrospective appeal processes to recover denied reimbursements, using a coding knowledge base and payor regulations.

You will collaborate with coding and payor teams, prepare appeal letters, review denials, and identify root causes to improve processes and ensure timely appeals.

Responsibilities

• 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.

Job description

UPMC Corporate Revenue Cycle is hiring a Retrospective Appeal Coder to join our team! This position will work remotely, Monday through Friday.

The Retrospective Appeal Coder provides support to the local coding departments by initiating the retrospective appeal process for coding denials. Drawing on a coding knowledge base and knowledge of payor regulations, the Retrospective Appeal Coder is responsible for assessing for the presence of criteria to recover denied reimbursement through appeal.

Responsibilities:

• 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.