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Denials Coder

CHI Health Clinic Omaha, Nebraska
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Requisition ID 2022-231841 Employment Type PRN Department HIM Coding Hours/Pay Period 0 Shift Varies Weekly Schedule Varied; 10-30 hours per week Remote Yes Category Medical Coding
Overview

REMOTE WORK OPPORTUNITY

Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.

JOB SUMMARY / PURPOSE

Under direct supervision, this position is responsible for 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. The incumbent conducts 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. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies to bring timely resolution to issues that have a potential impact on revenues.
In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.


Responsibilities

ESSENTIAL KEY JOB RESPONSIBILITIES

1. Applies 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.
2. Communicates 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.
3. Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
4. Resubmits claims with necessary information when requested through paper or electronic methods.
5. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
8. Assists with unusual, complex or escalated issues as necessary.
9. Organizes 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.
10. Accurately documents patient accounts of all actions taken in billing system.
11. Other duties as assigned by management.


Qualifications

MINIMUM REQUIRED QUALIFICATIONS:

  • Knowledge of health insurance, including coding.
  • Ability to communicate effectively and efficiently.
  • Proficient computer skills,with the ability to learn applicable internal systems.
  • Ability to work collaboratively with others toward the accomplishment of shared goals.

PREFERRED QUALIFICATIONS:

  • High school diploma or equivalent preferred
  • Associates degree in related field
  • 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
  • CPC Certification

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.