AMN Healthcare
Remote Ip Coding Denials Specialist
The Inpatient Coding Denials Specialist is a high-level coding expert responsible for investigating and resolving coding related denials from payers, preventing lost reimbursement and promoting denial prevention. The Inpatient Coding Denials Specialist will adhere to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials. Position Duties: Analyzes documentation to support codes/DRGs and abstracted data (e.g., discharge disposition) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCS to include: Principal diagnosis code assignment Secondary diagnosis code assignment Procedure code assignment Discharge disposition Identifies and writes clear and concise appeal letters utilizing all available documentation, regulations and guidelines to defend the billed claim Utilizes the following resources to identify the root cause of the denial/downgrade: Explanation of Benefits/Remittance Advice Payer denial/DRG downgrade letters Complex NCD/LCD guidelines, CMS/AHCA policies and regulations Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites Escalates problem accounts/processes/trends and report opportunities to supervisor for denial prevention and coding education opportunities Maintains or exceeds established productivity standards Maintains or exceeds established accuracy standards As needed, may periodically be asked to perform Coding Integrity Specialist III (CIS-III) or Coding Account Resolution Specialist III (CARS-III) duties Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current Meets all educational requirements as stated in current Company and HSC policy Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" Other duties as assigned Minimum Required Qualifications: Coding Technical Skills Expert knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGs, APR-DRGs, discharge disposition, and POA Assignment. Regulatory Technical Skills Expert knowledge of Local Coverage Decisions / National Coverage Decisions, Hospital Acquired Conditions, Severity of Illness / Risk of Mortality, Post-Acute Care Transfer regulations, Patient Safety Indicators. Communication - communicates clearly and concisely, both verbally and in writing. Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations. Analytical Skills effective evaluation, synthesis and use of information gathered. Initiative independently takes prompt proactive steps toward problem resolution. Organization establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task. Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems. PC Skills - demonstrates proficiency in Microsoft Office applications and others as required. Quality Orientation accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Work Independently is self-supporting; not needing to rely on others to complete a job. Preferred Qualifications: Undergraduate (associate or bachelors) degree in HIM/HIT. 5 years experience. RHIA, RHIT or CCS Education and Skills: High school diploma or equivalent required. Requires one of the following coding credentials: AHIMA (CCS, RHIA, or RHIT, ONLY). Must be proficient with Facilities Coding Standards. Minimum of three (3) years' experience in medical coding. Working knowledge of ICD-10-CM/PCS. Salary and Benefits: Paid Time Off and Sick Time 401K Medical, Dental, Life and Long/Short term disability Insurance Paid Association Dues Paid Educational Benefits AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.
The Inpatient Coding Denials Specialist is a high-level coding expert responsible for investigating and resolving coding related denials from payers, preventing lost reimbursement and promoting denial prevention. The Inpatient Coding Denials Specialist will adhere to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials. Position Duties: Analyzes documentation to support codes/DRGs and abstracted data (e.g., discharge disposition) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCS to include: Principal diagnosis code assignment Secondary diagnosis code assignment Procedure code assignment Discharge disposition Identifies and writes clear and concise appeal letters utilizing all available documentation, regulations and guidelines to defend the billed claim Utilizes the following resources to identify the root cause of the denial/downgrade: Explanation of Benefits/Remittance Advice Payer denial/DRG downgrade letters Complex NCD/LCD guidelines, CMS/AHCA policies and regulations Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites Escalates problem accounts/processes/trends and report opportunities to supervisor for denial prevention and coding education opportunities Maintains or exceeds established productivity standards Maintains or exceeds established accuracy standards As needed, may periodically be asked to perform Coding Integrity Specialist III (CIS-III) or Coding Account Resolution Specialist III (CARS-III) duties Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current Meets all educational requirements as stated in current Company and HSC policy Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" Other duties as assigned Minimum Required Qualifications: Coding Technical Skills Expert knowledge of ICD-10-CM, ICD-10-PCS, MS-DRGs, APR-DRGs, discharge disposition, and POA Assignment. Regulatory Technical Skills Expert knowledge of Local Coverage Decisions / National Coverage Decisions, Hospital Acquired Conditions, Severity of Illness / Risk of Mortality, Post-Acute Care Transfer regulations, Patient Safety Indicators. Communication - communicates clearly and concisely, both verbally and in writing. Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations. Analytical Skills effective evaluation, synthesis and use of information gathered. Initiative independently takes prompt proactive steps toward problem resolution. Organization establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task. Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems. PC Skills - demonstrates proficiency in Microsoft Office applications and others as required. Quality Orientation accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Work Independently is self-supporting; not needing to rely on others to complete a job. Preferred Qualifications: Undergraduate (associate or bachelors) degree in HIM/HIT. 5 years experience. RHIA, RHIT or CCS Education and Skills: High school diploma or equivalent required. Requires one of the following coding credentials: AHIMA (CCS, RHIA, or RHIT, ONLY). Must be proficient with Facilities Coding Standards. Minimum of three (3) years' experience in medical coding. Working knowledge of ICD-10-CM/PCS. Salary and Benefits: Paid Time Off and Sick Time 401K Medical, Dental, Life and Long/Short term disability Insurance Paid Association Dues Paid Educational Benefits AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.