Coder - AR Denial Specialist

***Work at Home***

TOA has an immediate opening for a Coder, AR Denial Specialist. This position is primarily responsible for monitoring and working denials, appeals, and denial resolutions with our participating payers. The coder will have extensive knowledge and understanding of payer rules and guidelines, coding rules and guidelines, and redeterminations and appeal guidelines.

The success factors specifically include:

• Responsible for the utilization review and technical appeal of clinically related denials (concurrent and retro), achieving optimal financial outcomes for TOA. This includes expert utilization and application of Encoder Pro and NextGen.
• Represents TOA providing formal appeals via letter and phone to managed care payers. Appeal processes include but are not limited to the review of utilization review, billing, coding, charging, and clinically related technical errors.
• Working the NextGen databases documenting clinical and technical denial information which can then be further analyzed.
• Reports TOA trends regarding patterns of denials and outcomes of appeals using a data-driven approach.
• Utilize a clear and fluent understanding of payer rules and guidelines and coding rules and guidelines.

The position will require the individual to work in different payer websites, file redeterminations, and appeals, and follow up on those redeterminations and appeals. The individual will be expected to migrate between projects smoothly and effectively to ensure that denials are worked timely, efficiently, and appropriately.

The successful candidate will have considerable success and experience in AR follow-up, specifically coding-related denials. Additionally, the role requires these qualifications and/or experiences:

• Must be daily commutable to work in and reside in the Middle TN, Columbia, or Knoxville areas
• Possessing credentials such as CPC-CCS-P is strongly preferred, but not a requirement
• Orthopaedic AR experience preferred, but not required
• Posses and maintains working knowledge of the redetermination process and the appeals process to ensure proper AR follow-up
• Posses and maintain working knowledge of surgical coding process, modifiers, bundling rules, anatomy, etc.
• Posses and maintain working knowledge of ancillary services, including but not limited to PT, OT, MRI, DME, and Injectables
• Demonstrated success in analyzing denial reports in order to identify trends
• Proficiency in personal computers, MS Office Word & Excel
• Exceptional communication, with demonstrated success communicating and influencing stakeholders including revenue cycle, physicians and providers, insurance companies, and others.
• Fluency in EHR systems, with NextGen experience a plus
• College degree is preferred, and a high school diploma or equivalent is required.