Denial Coder

Description

The Denial Coder will have frequent interactions with internal and external clients including but not limited to Physician and Non-physician Surgical Providers. Responsibilities include primary diagnosis and procedural coding for the designated major surgical specialty areas (Orthopedics) and other major procedural areas including capture of applicable Physician Quality Reporting System (PQRS) and reconciliation of all daily charges performed at each medical office where applicable. The Denial Coder focuses their work on the detailed physician surgical encounter abstraction as well as being an immediate liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes for the providers in these areas. Daily abstraction coding is defined as identification of codes based solely on the source documentation for CPT and ICD-10-CM respectively.

Responsibilities

• The Denial Coder is responsible for reviewing and analyzing charges denied for a coding-related issue
• Review and/or update any charge denied for a coding-related issue
• Knowledge of Radiology, Orthopedics (including Sports Medicine, Upper and Lower Extremities, Spine), Podiatry, Pain Management, Rheumatology and/or DME coding and billing extremely desired
• Answer management, customer service and other department emails
• Work and communicate with office and surgical coding teams
• Provide denial trends to leadership and peers for root cause solutions
• Research payer requirements, such as LCD/NCD Lists
• Assigning CPT, HCPCS, ICD-10-CM
• Ensuring compliance with medical coding policies and guidelines
• Expected to meet monthly productivity benchmarks and have an accuracy rate of 95% on audits
• Management maintains the right to assign or reassign duties and responsibilities to this job at any time
• Adheres to and supports the objectives, policies and procedures of Illinois Bone and Joint Institute
• Supports the development and implementation of improvement initiatives as it relates to the department goals.
• Maintains confidentiality of patient information according to HIPAA guidelines. 
• Adheres to policy and procedures according to Employee Handbook

Requirements

Education:

High School Diploma or equivalent required.  

Associate or bachelor’s degree in medical record administration or equivalent is preferred.

Experience: A minimum of three (3) years’ experience coding and charge processing in a non-facility (physician or medical group in multi-specialty surgical practices) setting required. Must be able to code charges based on reading and interpreting medical documentation.

Degrees, Licensure, and/or Certification:

Certified Coding Specialist (CCS-P) or Certified Professional Coder (CPC) is required.

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) is a plus.

Skills and Aptitudes:

Extensive knowledge of coding non-facility procedures, applicable modifiers in multi-specialty setting

Understands and applies appropriate Center Medicare Services (CMS) guidelines to coding.

Advanced ICD-10-CM & CPT-4 coding conventions.

Understanding of Anatomy & Physiology and Medical Terminology

Coding software familiarity i.e., Codify etc.

Coding from medical documentation

Effective written and verbal communication skills

Data entry

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week):  medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.