Acute Coding Appeals Specialist

The Opportunity

Career Opportunity Offering:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

This position pays between $29.70 - $31.80 based on experience.

Job Responsibilities

The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals/denials activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns.

Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate.

Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client.

Affords assistance in education and training for client coding companion as it relates to the outcomes of the coding appeals.

Meets established productivity standards for coding appeals & coding certification requirement.

Attends in-house sessions to receive updated coding information and changes in coding and/or regulations.

Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.

Required Experience

• Previous inpatient facility coding experience, working appeals, denials and edits
• 5 years previous experience in coding, required
• Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences

Minimum Education

High School Diploma or GED

Required Certification

Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.)

About the Role

O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

Qualifications

Remote Position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Skills

Previous inpatient facility coding experience, working appeals, denials and edits

Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements

Inquisitive and demonstrates openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences

Benefits

Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.

Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.

Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.

Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Pay

This position pays between $29.70 - $31.80 based on experience.

Schedule

This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.