Coronis Ajuba Solutions Pvt Ltd | Full timeCoding Denials SpecialistPasig City, Philippines | Posted on 10/21/2024Coronis Ajuba stands as a premier global provider of business process outsourcing solutions to healthcare organizations in the U.S. The organization partners with hospitals, health networks, physician practices, and related industry service organizations to provide a broad portfolio of customizable RCM solutions, uncover and capitalize on hidden financial opportunities, improve productivity and, ultimately, increase profits.Job DescriptionJOB SUMMARY: The Coding Denial Representative is responsible for reviewing payor denials and identifying the root cause of the denied accounts. The representative determines if the account is appealable or not and must understand and comply with the processes established by Federal and State regulations, payor-specific guidelines, and Official Coding Guidelines while navigating the system properly. The Coding Denial Representative must ensure the confidentiality and privacy of information.Essential Functions:Performs retrospective (post–discharge/post-service) medical record quality audits to determine the appellate potential of claims with denied reimbursement related to inpatient and outpatient coding data.Constructs and documents a succinct and fact-based case to support the appeal utilizing appropriate resources and medical record documents to support the appeal (Resources include AHA Official Coding and Reporting Guidelines, CMS guidelines, ICD-10, and CPT coding).Demonstrates ability to critically think, problem-solve, and make independent decisions supporting the coding appellate process.Demonstrates proficiency in achieving accuracy and consistency in the selection of principal and secondary diagnoses (including MCC and CC) and procedures. Provides education/feedback and coding guidance to clients regarding coding cases that did not warrant appeal resolution.Demonstrates proficiency in utilizing electronic tools during the medical record quality review process including but not limited to application of coding guidelines; patient accounting application; work listing application; visual imaging/scanning application; payor websites, electronic medical record, following Conifer's training of Assigned Personnel: Conifer's system ACE, Invision, Star, Meditech, EPIC, MedAssets (formerly IMaCs), eCARE, Authorization log, InterQual, VI, HPF, as well as competency in Microsoft Office.Demonstrates basic patient accounting knowledge, i.e., UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, etc.Serves as a resource to non-coding personnel by responding to clinical team questions/consults if needed.Writes the appeal letter (and electronically transmits the letter) in the appropriate host system: ACE, Invision, Star, Meditech, EPIC, MedAssets, or others as may be applicable.Follows client's operational and compliance policies and procedures, as applicable.Performs as a team player.Uses logic, critical thinking, and reasoning to identify the strengths and weaknesses of alternative solutions to problems.Understands the effects of new information for both current and future problem-solving and decision-making.Maintains high attention to detail.Adheres to attendance in accordance with company HR and department policies.Performs other tasks/functions that may be assigned by the company as per business requirements; these may change from time to time to reflect the changing requirements of the position and the business.
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