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CPT, ICD-10, and DRG coding. An Appeals Nurse Coordinator II will have experience with utilization management, DRG clinical validation, understand the state and federal regulations, have knowledge/experience with the denials and appeals process and have experience with physician documentation and electronic health records.
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License or Certification: This position requires an applicable CDIS or HIM (coding) credentialing through ACDIS, AHIMA, and/or AAPC. Or, this position requires an LPN or RN licensure with three years of ICD-10 and/or CPT/HCPCS coding.
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You have training and experience in evidence-based modalities of care such as CBT, DBT, EMDR, ACT, CPT. We have raised over $300 million from prominent investors including Kinnevik, Tiger Global, Northzone, RRE Ventures, Rethink Impact, Work-Bench, William K Warren Foundation, SemperVirens, Able Partners, True Capital Ventures, and a strategic investor, Guardian Life Insurance.
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Operating Geoprobe unit for the collection of soil and Cone Penetrometer (CPT) data. Perform drill rig and support truck maintenance- Reporting all repair and maintenance issues to the Drilling Supervisor.
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Strong working knowledge of ICD-10, CPT, HCPCS, referrals and pre-certification procedures, as well as documentation guidelines. Ability to read and interpret LCD/NCD requirements in regard to CPT and HCPCS denials.
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Identify appropriate assignment of CPT and ICD-10 Codes for outpatient Ambulatory Same Day Surgery services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility.
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Minimum three (3) years collections experience in an Insurance Collector role or equivalent experience in a medical facility, ambulatory surgery facility, or acute-care hospital; Knowledge of CPT, HCPCS, ICD-9 and medical terminology.
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Required Experience: 2 years' experience with insurance billing requirements and account follow-up procedures including experience researching and resolving claims denied by insurance carriers, and a general understanding of ICD9 and CPT coding; or equivalent combination of education and experience.
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Collaborates with corporate Compliance team to establish, develop, and maintain a library of ICD, PCS, CPT/HCPCS trainings, in conjunction with external coding contractor as needed. with the assigned Division Quality Director.
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Supports staff by data entry of registration information and charge entry, and verification of insurance eligibility and benefits as needed. Communicates with facilities to obtain prior authorization information and/ or consent forms.
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Professional coder certification with credentialing from AHIMA and/or AAPC (ROCC, CPC, COC, CPC-P, CCS) to be maintained annually. Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360.
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These include ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures. These include ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures. The Director of Managed Care Analytics is responsible for supporting the Vice President Managed Care as well as the Managed Care Contracting team in contract modeling, strategic planning, budgeting, financial analysis, and evaluating potential acquisitions.
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Versed in CPT code sets and requirements including but not limited to modifiers, CPT bundling/unbundling, proper diagnosis assignment, Evaluation and Management Codes, Lab Codes, and ASC HCPC code sets.
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The Specialist is responsible for reviewing (auditing) medical records to ensure proper billing of professional claims by comparison of provider or coder chosen CPT, HCPCS, HCC, and ICD-10 codes to the providers' documentation to substantiate the appropriate code level, code choice, or necessity of the service.
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