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Acts as a liaison for issues affecting various teams (coding, revenue integrity, accounts receivable (AR) follow up, etc.) Five years of certified coding experience with coding denials+ Accounts receivable follow up experience preferred.
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Works assigned claim edit and follow up work queues and meets the assigned productivity standards on a daily basis as well as assigned patient account work queues and responds with resolutions within the expected time frame.
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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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High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.) 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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CCS - Certified Coding Specialist (AHIMA) 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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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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Partners with revenue cycle leadership and peers and clinical operations to reduce denials. Makes recommendations to revenue cycle leadership on operations and root causes and assists in development of strategies to avoid future claim edits and denials.
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Follow-up with patient as appropriate to ensure compliance with recommendations, medications, lab/x-ray results, special visits, PCP visits, dieticians, diabetes educators, etc. CPT - Phlebotomy Technician Certification.
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The Referral Coordinator will be primarily responsible for the tracking of outstanding patient referrals and follow up calls to patients to secure an appointment, the maintaining of referral folders including archiving, entry into patient accounts, and providing direct communication with referring provider offices on status on pending referral requests.
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Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals. Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness.
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Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials. 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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Maintain list of orthotics received, contact patients and make follow up appointments. Knowledge about health insurance, pre-authorization, insurance verification, medical terminology, CPT codes and ICD-9 codes preferred.
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Daily review and follow up of unbilled appointments in scheduler and ready to bill queues. Knowledge of HCPC, CPT and ICD-10 coding. Knowledge of HCPC, CPT and ICD-10 coding. 1-2 years Billing and Coding Experience Required.
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