Healthcare Coder Denials Experience a Must Have

PURPOSE AND SCOPE:

The Denial’s Coder performs data entry processing within the assigned function(s). The incumbent is responsible for applying appropriate diagnosis, HCPC, CPT, Modifiers and any other claims and/or medical justification identified upon claim denial or charge review resulting in an accurate accounting of the services The Coder provides administrative support in the interpretation and explanation of data for internal and external customers.

DENIALS MEDICAL CODER FOCUS:

• Must have 2+ years of “Denials” experience within medical healthcare coding
• Requires strong Excel skills
• Requires excellent analytical skills and critical thinking skills
• Chart review experience required
• AAPC or AHIMA Certification required
• Required to pass Assessment

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Under general supervision, assign the appropriate diagnostic and/or procedural code(s) to patient health information documents.
• Research and resolve specific billing, coding, and medical necessity denials, communicating with cross-divisional teams and/or business partners as necessary.
• Generate and distribute general reports for management review on a routine basis where applicable.
• Work collaboratively with cross-divisional teams on diverse processes in the achievement of shared goals within established timelines.
• Assist with various projects as assigned by direct supervisor.
• Initiates appeal/reconsideration requests per payer guidelines.
• Initiates re-bill of unpaid or underpaid claims.
• Ensure levels of follow-up are completed within established payer filing limits.
• Researches and identifies complex claims issues and discrepancies and escalates to supervisor for resolution as needed.
• Identifies and communicates improvement opportunities to denial management leadership to ensure timely and accurate payment.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION:

High School Diploma required

AAPC or AHIMA Certification required

EXPERIENCE AND REQUIRED SKILLS:

• Requires 2+ years' related Denials Medical Coding experience.
• Great computer skills with demonstrated proficiency in word processing, spreadsheet and email applications.
• General knowledge of governmental rules and regulations as they affect billing and coding processes.
• Detail oriented with strong analytical and organizational skills.
• Strong time management skills with the ability to multitask concurrent priorities in an organized manner.
• Strong interpersonal skills with the ability to work cohesively within a team environment.
• Possess a positive, enthusiastic and energetic attitude.
• Excellent oral and written communication skills to effectively communicate with all levels of management.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.