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CHI · 2 hours ago

Denials Coder

Omaha, NE

Full-time

Onsite

Entry Level

$19.87/hr - $28.06/hr

1+ years exp

CHI is a healthcare organization that provides a range of medical services. They are seeking a Denials Coder to manage and resolve outstanding insurance balances related to coding denials, ensuring compliance with established standards and guidelines.

Health CareHospitalMedicalNon Profit

Responsibilities

Corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements

Conducting follow-up process activities through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently

Reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals

Applying a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received

Communicating 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

Reviewing patient medical record to compare documentation and coding; changing coding based on documentation to include diagnosis codes, modifiers, place of service, etc

Communicating with provider to resolve claims that require a written appeal or second level appeal

Resubmitting claims with necessary information when requested through paper or electronic methods

Anticipating potential areas of concern within the follow-up function; identifying issues/trends and conducting staff training to address and rectify

Recognizing when additional assistance is needed to resolve insurance balances and escalating appropriately and timely through defined communication and escalation channels

Resolving work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides

Assisting with unusual, complex or escalated issues as necessary

Organizing open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc

Accurately documenting patient accounts of all actions taken in billing system

Qualification

ICD-10 codingCPT codingMedical terminologyInsurance follow-upAnalytical skillsAttention to detailEffective communication

Required

High School / GED: Required

Preferred

Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology

Completion of ICD-10 or CPT coding Course

1+ years coding experience

Insurance follow up experience

Company

CHI

Glassdoor3.5

Catholic Health Initiatives, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care.

Founded in 1996

Englewood, Colorado, USA

10001+ employees