Outpatient Denial Coder

CodingAID, a division of Managed Resources Inc. is a nationwide leading provider of medical coding support, coding and compliance reviews, educational programs, recruitment, revenue cycle management, and many other managed healthcare solutions. Weâ re proud to have served healthcare organizations and medical groups for 30 years with proven success in meeting their operational challenges.

Purpose: The Coding Denials Specialist will be responsible for: reviewing and resolving coding-related denials; interpreting and applying payer guidelines; tracking and trending denial data to help prevent future denials and identify trends with specific payers; and more

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:

Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue

Proficient in working denials for multispecialty coding, along with E&M coding for all places of services

Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting

Research as required any updates, and regulatory compliance

Accurately code conditions and procedures as documented and in accordance with official coding guidelines established for use with mandated standard code sets

Reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines

Performs other Coding functions as appropriate, including assisting with coding backlogs as necessary

Performs other duties as assigned

Ideal candidate will possess the following:

Must hold the following credential: CPC, CCS-P, or CCS

A minimum of (3-5) years previous physician coding experience with experience working claim edits and denials

3-5 years ICD-10 and CPT coding experience

Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue

Experience creating appeal letters as appropriate and communication with billing teams within Guide house or within a client organization

Must have experience working in systems such as EPIC, Cerner, Next Gen, Allscripts or other EHR

Excellent verbal and written communication skills

Ability to interact with management personnel

Possess strong organizational skills and attention to detail

Adaptive and flexible to new ideas and change

Ability to work in a changing environment

Participate in special projects as needed