Medical Coder

Job Summary

We are looking for individual to join our client’s team as Denials Analyst. Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends, and providing monthly reports. Responds to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirement for preauthorization, medical necessity, and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.

Job Description

HOSPITAL-WIDE SUPPORTING COMMITMENTS

GROWTH: Inpatient and outpatient volumes are steadily increasing.

• Demonstrates a commitment to change and growth in approach toward daily work
• Mobilizes the resources and energies of the health system towards success
• Looks for new business opportunities and makes suggestions for expanding our services
• Words and actions reinforce client as an indispensable health care resource and promotes the likelihood of recommending the health system

CLINICAL EXCELLENCE: Ensure that measured outcomes meet/exceed agreed upon expectations. Evidence based clinical practice policies, procedures, and other standards are practiced 100% of the time. Tests, treatments and procedures are thoroughly explained to patients and are understood. Patients, visitors and donors are always safe from harm and prefer client because of its high quality.

• Adheres to hospital and department safety and compliance policies and procedures
• Wears identification badge at all times ensuring it can be read
• Completes annual health, safety, compliance reviews and any department/hospital specific requirements within the expected timeframe
• Acts as a Steward for Safety and corrects and/or reports any unsafe conditions to extension 4759 or employeesafety@emc.org
• Understands the importance of immediately reporting on-the-job injuries online and to your supervisor
• Accepts responsibility for own work
• Monitors own work to ensure quality; participates in continuous quality improvement
• Maintains sound judgment and reasoning; analyzes problems or procedures & selects correct course of action
• Explains tests, procedures, and services with patients to ensure thorough understanding
• Engages in opportunities to learn and grow by participating in training and educational programs

COURTESY/CARING: Staff always practice good manners, are friendly, polite and emotionally sensitive to each individual whether patient, family, visitor or fellow employee.

• Acknowledges each person in a sensitive, friendly contact & offers assistance as needed
• Provides an ”ideal” level of service by taking immediate action in addressing customer requests, needs, and concerns
• Uses pleasant/appropriate tone and positive verbal/nonverbal/written communication at all times
• Answers telephone by identifying department and name; and asks “How may I help you?”
• Treats everyone with courtesy and respect, not making excuses nor blaming other employees or departments; works together to improve customer service

PARTNERSHIP: Medical Staff, volunteers and employees are committed and highly engaged. Leadership and the staff are constantly striving for professional growth and applying that new knowledge to innovate and continuously improve direct patient care and other supporting systems and procedures.

• Treats co-workers as teammates, accepts/supports team decisions and the roles of others
• Develops trust and credibility with peers, supervisors, and customers
• Helps others during slow periods
• Applies new knowledge to innovate and continuously improve direct patient care and other supportive systems and operations
• Provides helpful, courteous, timely, and accurate responses to all individual

HEALING ENVIRONMENT: A supportive setting is developed and maintained that embraces the physical, emotional, and spiritual aspects of health and healing.

• Maintains a professional image and a clean, orderly environment that portrays an overall image of excellence
• Demonstrates compassion when dealing with difficult situations & takes initiative to resolve
• Creates a positive environment by not engaging in inappropriate communication
• Demonstrates a can-do attitude and embraces the culture of performance excellence
• Actively promotes a supportive setting that embraces the physical, emotional, and spiritual aspects of health and healing by creating a quiet, calm, pleasant and cheerful environment

EFFICIENCY: Services are provided efficiently and effectively with a minimum of waste.

• Adheres to all rules & standards around productivity, timeliness, overtime, & meal/rest periods
• Balances individual/team responsibilities to produce more efficiently
• Pays close attention to detail to standardize work, and eliminate waste and rework
• Makes a concerted effort to conserve hospital resources, i.e. electricity, supplies, water, etc.
• Adheres to all hospital, division and department policies and procedures

ESSENTIAL RESPONSIBILITIES:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
• Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods
• Identify, track and report on denial trends
• Maintain an appeals data base to identify and report outcomes and opportunities
• Identify any billing and/or coding trends resulting in denials and report to the Coding manager
• Identify any other trends resulting in denials and report to Manager.
• Attend all available coding and appeals related seminars as available
• All other duties as assigned

Skills Required

• Experience with Epic Hyperspace for HB billing
• Particular emphasis on Claims, follow up and denials work queues
• Experience working payor denials and drafting/sending appeals
• Basic knowledge understanding of Medicare reimbursement for inpatient and outpatient claims
• Preferred 2 yr of previous claims follow up experience
• Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
• Preferred: three to five years of Patient Accounting in a high volume environment.
• Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
• Ability to prioritize and coordinate workflow and attention to detail.
• Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
• Working knowledge of LCD’s, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.
• Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
• Preferred: three to five years of Patient Accounting in a high volume environment.

Education/Training/Certifications

• Required: High School diploma or equivalent
• Preferred: Associate degree
• Preferred: Certified coder or currently enrolled in a coding program

Additional Requirements

• Reports to: Manager, Denials Analytics
• 8 hour shifts

We are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law.