Job Description

Job Title

Denials Management Coder

Job Purpose

Responsible for reviewing denied claims for coding related errors and determining appropriate action. The Denials Management Coder will be responsible for corrections to individual accounts with include CPT and/or ICD-10 Corrections, applications of correct modifiers, etc. The coder is also responsible for ensuring that government and local guidelines are followed. Payers include but not limited to Medicare, Medicaid, Blue Cross, and commercial health insurance carriers.

Duties and Responsibilities

• Read and interpret insurance carrier EOBs.
• Review medical reports, verify coding.
• Resolve coding related denial.
• Make any necessary coding corrections.
• Generate replacement claims (electronic and paper)
• Research carrier specific coding policies.
• Review and interpret carrier NCD and LCD policies.
• Communicate any coding denial trends to coding manager.

Qualifications

• CPC/COC certification AAPC or CCS certification from AHIMA
• Minimum one (1) year of coding experience related to the specialty needed (Coding Denials)
• Knowledge in Medicare and Medicaid guidelines preferred.
• Working knowledge of managed care, commercial insurance, Medicare/Medicaid.
• Understanding and adherence to HIPAA and PHI Guidelines.
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Documentation and data entry skills
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Work Set-up: Work From Home
• Work Schedule: Predominantly dayshift; must be flexible to accommodate business needs.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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