Denial Specialist-Coding - Revenue Cycle FT Days - Service Center

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Denial Specialist-Coding - Revenue Cycle – FT Days - Service Center (Omaha)','Full-time','Professional Non-Clinical','Days','Days','80','80','Occasional','Occasional','NEBRASKA-OMAHA-SERVICE CENTER-NORTH BLDG','','!*!
CHI Health is a regional health network with a unified mission: nurturing the healing ministry of the Church while creating healthier communities. Headquartered in Omaha, the combined organization consists of 15 hospitals, two stand-alone behavioral health facilities and more than 150 employed physician practice locations in Nebraska and southwestern Iowa. More than 12,000 employees comprise the workforce of this network that includes 2,820 licensed beds and serves as the primary teaching partner of Creighton University’s health sciences schools. In fiscal year 2014, the organization provided a combined $149.3 million in quantified community benefit including services for the poor, free clinics, education and research. With locations stretching from Kearney, Neb. to Missouri Valley, Iowa, the health network is the largest in Nebraska and serves residents of Nebraska and southwest Iowa. For more information, visit online at CHIhealth.com.
 
ESSENTIAL JOB RESPONSIBILITIES
Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.


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.

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.

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.

Resubmits claims with necessary information when requested through paper or electronic methods.  

Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.

Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

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.

Assists with unusual, complex or escalated issues as necessary.

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.

Accurately documents patient accounts of all actions taken in billing system.
Identifies potential trends in denials/reimbursement by payer or by type, denial reason, or coding issue and reports to supervisory staff for appropriate escalation. 

Uses critical thinking skills and payer knowledge to recommend system edits to reduce denials and result in prompt and accurate payment.

Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.

Communicates with supervisor and staff regarding insurance carrier contractual and regulatory requirements that impact payment and denials.
Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.

Meets quality assurance and productivity standards for timely and accurate denial resolution in accordance with organizational policies and procedures.
Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.

Understands detailed billing requirements, denial reason codes, and insurance follow-up practices.

Understands government and commercial insurance reimbursement terms, contract language, and appropriate reimbursement amounts.

Has knowledge of, and is compliant with, government regulations including signature on file requirements,   compliance program, HIPAA, etc.
Establishes and maintains professional and effective relationships with peers and other stakeholders.

Works collaboratively with payers and revenue cycle staff to explain denial or underpayment issues.

Establishes and maintains a professional relationship with clinics and staff in order to resolve issues.

Promotes an atmosphere of collaboration so peers feel comfortable approaching with issues and challenges specific to their payer or specialty.

Depending on role and practice management system training, may be called upon to support other areas in the Revenue Cycle.

 
MARGINAL JOB RESPONSIBILITIES

Other duties as assigned by leader and organization.','!*!




Required Education and Licensure


High school/GED


Required Minimum Experience


 Three years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.
 


Bona Fide Occupational Qualifications (BFOQs)


N/A


Preferred Qualifications


Graduation from a post-high school program in medical billing or other business-related field is preferred.
Certification (AHIMA, CPC, or CCS-P)
2 years coding experience 


Minimum Knowledge, Skills, and Abilities


Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
Knowledge of the insurance follow-up process for government and non-government payers.
Knowledge of clinic operations related to patient registration, referrals and cash collections.
Knowledge of general office principles, practices, standards, systems and tools/equipment.
Knowledge of medical insurance, payer contract, and basic medical terminology and abbreviations.
Knowledge of Coding to include:  CPT and ICD10.
Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
Knowledge of sources and availability of information relevant to the assigned function.
Knowledge of the operation and application of automated systems applicable to the assigned function.
Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
Ability to identify and articulate non-compliance with established guidelines and/or regulatory requirements.
Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
Ability to effectively prioritize and execute tasks while under pressure.
Ability to make decisions based on available information and within the scope of authority of the position.
Ability to demonstrate excellent customer service skills, including professional telephone interactions.
Ability to read, understand and communicate in English sufficient to perform the duties of the position.
Ability to establish and maintain effective working relationships as required by the duties of the position.
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency
','We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.','2017-R0131067','CHI Health','Denial Specialist-Coding - Revenue Cycle – FT Days - Service Center (Omaha)

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