[Hiring] Acute Coding Appeals Specialist @Ensemble Health Partners

Role Description

The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. This role draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS, and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues and quality concerns. Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for inpatient Diagnosis Related Group (DRG) denials to support the assigned DRG and address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes.

Job Responsibilities

• Integrate medical coding principles and objectivity in coding appeals/denials activities.
• Participate in client system education to ensure coding is supported by the patient's clinical documentation and regulatory standards.
• Maintain meticulous documentation, spreadsheets, and claim examples of root cause issues.
• Perform searches of governmental, payor-specific, hospital-specific, and regulatory body rules to identify coding and billing requirements.
• Assist in education and training for client coding companions related to coding appeals outcomes.
• Meet established productivity standards for coding appeals and coding certification requirements.
• Attend in-house sessions to receive updated coding information and changes in regulations.
• Provide excellent customer service in an organized and efficient manner while maintaining a positive attitude.

Qualifications

• Previous inpatient facility coding experience, working appeals, denials, and edits.
• 5 years previous experience in coding, required.
• Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes.

Requirements

• High School Diploma or GED.
• Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.).
• This is a remote position; candidates must be willing and able to travel to and work onsite as business needs require.

Benefits

• Bonus Incentives.
• Paid Certifications.
• Tuition Reimbursement.
• Comprehensive Benefits.
• Career Advancement.
• This position pays between $29.70 - $31.80 based on experience.