Denials And Appeals Specialist II (Remote Medical Coding)

Job Description

POSITION SUMMARY Reviews and responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Reviews denial trends and identifies coding issues and knowledge gaps. Collaborates on operational performance and department quality improvement activates and committees. RESPONSIBILITIES

• * Liaise between the RAC, commercial payers, managed care and third party review organizations.
• Manages timely review, investigation and response to coding denials.
• Establish denial reviews and response processes.
• Prioritizes and reviews cases denied by commercial payers.
• Determines actions required for appeals within contractual timeframes.
• Reports program performance and/or corrective action to management on regular basis.
• Monitors inpatient denial types, volume and formulates responses to requesting agency. Seeks additional resources (e.g. legal counsel) to resolve issues, as needed.
• Develops case-specific written rationale to substantiate and communicate findings.
• Reviews denial trends and identifies coding issues and knowledge gaps.
• Functions as a Health System resource for litigation as related to coding denials.
• Maintains Greater NY Hospital Association database.
• Functions as the Health System’s resource for the tracking system for government appeals.
• Remains up-to-date on DRG system literature from all agencies.
• Knowledge, understanding of Federal and NYS DRG’s.
• Maintains coding clinic up-dates.
• Performs related duties, as required.
• ADA Essential Functions

REQUIRED EXPERIENCE AND QUALIFICATIONS

• Bachelor’s Degree in Health Information Management or related field, preferred.
• Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
• RHIA, RHIT or RN, CCS, required.
• Strong written, communication, presentation and organizational skills, required.

Qualifications

REQUIRED EXPERIENCE AND QUALIFICATIONS

• Bachelor’s Degree in Health Information Management or related field, preferred.
• Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
• RHIA, RHIT or RN, CCS, required.
• Strong written, communication, presentation and organizational skills, required.
• Denials and appeals review strongly preferred.

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