Coding Specialist

4 days ago


Maryville, Tennessee, United States Anderson Hospital Full time
Job Summary

We are seeking a skilled Coding Specialist to join our team at Anderson Hospital. As a key member of our revenue cycle team, you will be responsible for reviewing inpatient and outpatient payer denials and initiating appeals with insurance companies.

Key Responsibilities
  • Review payer inpatient and outpatient denials and write appeal letters and/or respond to payers with review outcomes.
  • Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines.
  • Track inpatient denial and appeal activity using an Excel spreadsheet.
  • Research payer edits and denials related to medical necessity and other payer coding requirements, i.e. CMS, Medicaid.
  • Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
  • Communicate results of claims review activity to CDI, Physicians, and revenue cycle stakeholders.
Requirements
  • Education: RHIT, RHIA, or CCS.
  • Experience: Minimum of 2 years of inpatient coding experience. Denial/appeals management experience preferred, but not required.
  • Knowledge of ICD10 – CM and PCS, CPT-4, HCPCS.
  • Knowledge and experience with payer requirements, i.e. CMS medical necessity.
  • Strong analytical and organization skills.
  • Excellent oral and written communication skills.
  • Ability to multi-task and prioritize workload in a fast-paced environment.
  • Proficiency in Excel.
Working Conditions

The normal work routine involves no exposure to blood, body fluids or tissues. Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical or first aid.


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