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At Houston Methodist, the Coding Charges & Denials Specialist is responsible for coordinating and monitoring the coding specific clinical charges and denial management and appeals process in a collaborative environment with revenue cycle management and clinical partners at various Houston Methodist facilities.
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CPC - Certified Professional Coder (AAPC) Additionally, this position will collaborate with key stakeholders and assist in developing appeal strategies to include reference material for staff, letter templates, and regular feedback for revenue cycle coding staff; and functions as clinical subject matter expert related to coding denials and appeals.
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Functions as an educational liaison to clinical staff and revenue cycle staff as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations.
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Performs data mining and reporting activities that identify net positive impactful opportunities in denials and adjustments for the individual facilities and the system. This position will collaborate with physicians, revenue cycle personnel, and payers to successfully clear front end claim edits, appeal clinical denials, and address customer service inquiries.
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Partners with revenue cycle leadership and peers and clinical operations to reduce denials. Five years of certified coding experience with coding denials+ Accounts receivable follow up experience preferred.
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Makes recommendations to revenue cycle leadership on operations and root causes and assists in development of strategies to avoid future claim edits and denials. + Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals.
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Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness. Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials.
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Analyzes claim edits/denials to identify new trends, opportunities, and educational feedback as needed. , determines the causes for denials of payment and partners with management to implement strategies to prevent future denials.
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This includes reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes. High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.
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Acts as a liaison for issues affecting various teams (coding, revenue integrity, accounts receivable (AR) follow up, etc.) Works with revenue cycle management and staff to ensure claim edit/denial trending data is accurate and that all metrics are reported appropriately including specific current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals.
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CCS - Certified Coding Specialist (AHIMA) This position will be responsible for working assigned specialties and combines clinical knowledge to reduce financial risk and exposure caused by front end claim edits and retrospective denial of payments for services provided.
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Uniform Yes+ Scrubs Yes+ Business professional Yes+ Other (department approved) No. This includes, but not limited to, feedback to coding, clinical service areas, physicians, and other revenue cycle staff.
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Accreditation from a professional coding organization, such as American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) certification is required.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Certification: American Academy of Professional Coders (AAPC) – CPC or equivalent organization, American Health Information Management Association, AHIMA –CCS) for a minimum of 2 years. Researches, analyzes, and responds to inquiries regarding inappropriate coding, denials, and billable services in accordance with all CMS/Federal and state guidelines.
$23 - $34 an hourFull-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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AAPC billing and coding certifications, preferred. Assist customers with billing questions, claim denials, and appeals. The Field Reimbursement Manager is a part of the Customer Transformation team and reports directly to the EVP of Customer Transformation.
Full-timeExpandApply NowActive JobUpdated 8 days ago
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