Denials And Appeals Specialist II (Remote Medical Coding)

Job Description POSITION SUMMARY Reviews and responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Reviews denial trends and identifies coding issues and knowledge gaps. Collaborates on operational performance and department quality improvement activates and committees. RESPONSIBILITIES • * Liaise between the RAC, commercial payers, managed care and third party review organizations. • Manages timely review, investigation and response to coding denials. • Establish denial reviews and response processes. • Prioritizes and reviews cases denied by commercial payers. • Determines actions required for appeals within contractual timeframes. • Reports program performance and/or corrective action to management on regular basis. • Monitors inpatient denial types, volume and formulates responses to requesting agency. Seeks additional resources (e.g. legal counsel) to resolve issues, as needed. • Develops case-specific written rationale to substantiate and communicate findings. • Reviews denial trends and identifies coding issues and knowledge gaps. • Functions as a Health System resource for litigation as related to coding denials. • Maintains Greater NY Hospital Association database. • Functions as the Health System’s resource for the tracking system for government appeals. • Remains up-to-date on DRG system literature from all agencies. • Knowledge, understanding of Federal and NYS DRG’s. • Maintains coding clinic up-dates. • Performs related duties, as required. • ADA Essential Functions REQUIRED EXPERIENCE AND QUALIFICATIONS • Bachelor’s Degree in Health Information Management or related field, preferred. • Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background. • RHIA, RHIT or RN, CCS, required. • Strong written, communication, presentation and organizational skills, required. Qualifications REQUIRED EXPERIENCE AND QUALIFICATIONS • Bachelor’s Degree in Health Information Management or related field, preferred. • Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background. • RHIA, RHIT or RN, CCS, required. • Strong written, communication, presentation and organizational skills, required. • Denials and appeals review strongly preferred. Remote About the Company: CORPORATE