Denials Coder
About the Role
As a Medical Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time.
Responsibilities
- Apply a thorough understanding and interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
- Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding, denied, and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer-specific requirements.
- Review patient medical records to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc.
- Communicate with providers to resolve claims that require a written appeal or second-level appeal.
- Resubmit claims with necessary information when requested through paper or electronic methods.
- Anticipate potential areas of concern within the follow-up function; identify issues/trends and conduct staff training to address and rectify.
- Recognize when additional assistance is needed to resolve insurance balances and escalate appropriately and timely through defined communication and escalation channels.
Requirements
- Preferred: High School Graduate (General Studies) and 1+ years of coding experience, upon hire or High School GED (General Studies) and 1+ years of coding experience, upon hire.
- Associate’s degree in a related field and insurance follow-up experience, upon hire.
- Completion of college-level courses in medical terminology, anatomy and physiology, disease processes, and pharmacology, upon hire.
- Completion of ICD-10 or CPT coding course, upon hire.
Qualifications
- Certified Professional Coder, upon hire or
- Certified Professional Coder Hospital Apprentice, upon hire or
- Certified Professional Coder Apprentice, upon hire or
- Certified Coding Associate, upon hire or
- Cardiology Coding, upon hire or
- Certified Coding Specialist, upon hire or
- Certified Coding Specialist - Physician Based, upon hire or
- Certified Cardiovascular and Thoracic Surgery Coder, upon hire or
- Certified Health Care Compliance, upon hire or
- Certified Interventional Radiology Cardio Coder, upon hire or
- Certified Professional Coder Hospital, upon hire or
- Radiology Certified Coder, upon hire or
- Registered Health Information Administrator, upon hire or
- Registered Health Information Technician, upon hire.
Where You'll Work
From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations, with some clinics offering extended hours.
Pay
$19.87 - $28.06 per hour