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Description

PeaceHealth is seeking a Coding Denials Specialist. This position is remote but does require the associate to live / work in OR, WA, AK or TX to be eligible for consideration.

Job Summary

Coding Denials Specialist analyzes, processes, and resolves claim denial requests. Provides support to HIM Coding Process Analyst in answering email questions regarding denials, maintaining a wide range of payer deadlines, and reporting on denial functions.

Essential Functions

+ Reviews medical records as needed to verify matches in denial requests before they are processed.

+ Reviews denials for compliance with policies.

+ Communicates with insurance carriers, and/or providers, as well as CDI and Hospital Coding when questions arise regarding claim denial requests.

+ Processes letters from physician reviewer group on a timely basis.

+ Updates the organization and insurance companies about any delays in processing or issues to be resolved.

+ Reviews letters for accuracy, makes minor changes, saves letters to correct folders, and labels for processing.

+ Sorts denial letters from email into correct folders and label for processing.

+ Responds to emails with questions regarding DRG denials.

+ Moves denials through Code Audit system as different steps occur.

+ Prepares appeal packets, pulls supporting documentation from electronic health record.

+ Faxes/Emails/Uploads appeals to various payers in a timely manner.

+ Maintains a wide range of payer deadlines and ensures all denials are reviewed within the given time limit.

+ Monitors correspondence work queues for new correspondence related to DRG denials.

+ Routes clinical denials and rebuttals to different departments for review/appeal.

+ Compiles and sends weekly reports on denials without recoupment amounts.

+ Reviews letters for accuracy and completeness.

+ Responds to emails with questions regarding DRG denials.

+ Monitors correspondence work queues.

+ Performs other duties as assigned.

Qualifications

Education

+ High School Diploma Required: or equivalent and

+ Associate Degree Preferred: emphasis in Medical Terminology, Health Information Management, Project Management, Office Administration, Microsoft Office (Excel, Word, PowerPoint, Outlook)

Experience

+ Minimum of 1 year Required: General office, administrative experience and

+ Required: Basic knowledge of general office procedures and equipment and

Skills

+ Ability to use a complex EMR system. (Preferred)

+ Ability to manage conflict effectively and professionally. (Required)

+ Good customer service skills and interpersonal skills. (Required)

+ Ability to work independently with minimal supervision. (Required)

+ Proficient computer and keyboard including MS Office applications. (Required)

+ Good judgment and decision-making skills. (Required)

+ Strong organizational and analytical skills. (Required)

+ Excellent time management skills, with an emphasis on meeting time-sensitive deadlines. (Required)

+ Ability to handle interruptions due to phone calls, emails and questions. (Required)

+ Use of Teams technology to communicate with peers in different locations. (Required)

+ Good verbal and written communication skills. (Required)

+ Able to maintain a high degree of confidentiality. (Required)

+ Demonstrated knowledge of Medical Terminology and CPT/ICD 10 Coding. (Preferred)

+ Knowledge of insurance process and regulations. (Preferred)

Working Conditions

Lifting

+ Consistently operates computer and other office equipment.

+ Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

+ Sedentary work.

Environmental Conditions

+ Predominantly operates in an office environment.

Mental/Visual

+ Ability to communicate and exchange accurate information.

+ The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

The salary range for this job opening at PeaceHealth is $17.40 – $26.10. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility (https://www.thecaregiver.org/wp-content/uploads/2017/05/PeaceHealth-Statement-of-Commitment-to-Diversity-and-Inclusion-vFINAL.pdf) .

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

REQNUMBER: 114020