Clinical Denials Coding Review Specialist

Candidates must live within 60 miles of an HCA facility in ID, UT, NV, NH, TX, KS, MO, KY, TN, VA, GA, FL, SC and NC.

About the role

As a work-from-home Clinical Denials Coding Review Specialist, you will apply correct coding guidelines and payor requirements to research, analyze, and resolve outstanding clinical denials and insurance claims. This role involves regular outreach to payors and practices.

Responsibilities

• Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures
• Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate
• Compose technical denial arguments for reconsideration, including both written and telephonic communications
• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
• Identify problem accounts, processes, or trends and escalate as appropriate
• Utilize effective documentation standards that support a strong historical record of actions taken on the account
• Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information

Requirements

• Minimum two years of related experience in accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical/billing, medical payment posting, and/or cash application
• Prior experience reading and interpreting Explanation of Benefits (EOB)
• Coding certification through AHIMA or AAPC strongly preferred

Benefits

Parallon offers a total rewards package that supports the health, life, career, and retirement of our colleagues. Available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health, and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and consumer discounts

Note: Eligibility for benefits may vary by location.