PURPOSE AND SCOPE:
The Denial’s Coder performs data entry processing within the assigned function(s). The incumbent is responsible for applying appropriate diagnostic and procedural codes to patient health information for utilization in data retrieval, analysis and claims processing and identifying and resolving problems that lead to medical claim denials. 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
- Auditing 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 general coding issues; communicating with cross-divisional teams and/or vendors as necessary.
- Administer physician quality reporting initiative (PQRI) data to report quality measures; maximizing incentive payments at the time of billing.
- Generate and distribute general reports for management review on a routine basis.
- 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.
- Other duties as assigned.
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.
Occasionally lift and/or move up to 25 pounds.
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