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Job Overview

+ Performs critical research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation of denials

+ Maintains extensive caseload of coding denials.

+ Formulates strategy for prioritizing cases and maintains aging within appropriate ranges with minimal direction or intervention from Leadership.

+ Acts as a liaison among all department managers, staff, physicians and administration with respect to coding denials issues.

+ Assists with the development of denial reports and other statistical reports.

+ Reviews insurance coding-related denials, including but not limited to: Diagnosis codes not supported, incorrect or invalid CPT codes, modifier issues, and/or general coding error denials.

+ Responsible for reviewing assigned diagnostic and procedural codes against patient charts using ICD-10-CM, CPT, or any other designated coding classification system in accordance with coding rules and regulations.

+ Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.

+ Contacts insurance carriers as appropriate to resolve claim issues

+ Maintains payer portal access and utilizes said portal to assist in reviewing commercial medical policies

+ Maintains working knowledge of regulatory and third-party policies and requirements to ensure compliance; remains current with applicable insurance carriers’ timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to leadership.

+ Assists with short-notice timely filing deadlines for accounts with coding issues.

+ Provides feedback to the coding leadership team regarding coding denials.

+ Compiles training material and educational sessions associated with coding denial-related topics and presents such educational materials. Collaboratively works with the coding education team & coding compliance team to assist in providing education to coders, physicians and mid-level providers.

+ Monitors for coding trends, works collaboratively with the revenue cycle teams to prevent avoidable denials and reduce revenue loss.

Identifies, quantifies and communicates risk concerns to leadership and supports mitigation efforts as appropriate. Demonstrates the ability to analyze coded data to identify areas of risk and provide suggestions for documentation improvement

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.

EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status