Denials And Appeals Specialist II (reputed company Coding)

Job Description

POSITION SUMMARY Reviews and responds to reputed company payers, managed care and reputed company party review organizations in managing the appeals/denials process. Reviews denial trends and identifies coding issues and knowledge gaps. Collaborates on operational performance and department quality improvement activates and committees. RESPONSIBILITIES

• * Liaise between the RAC, reputed company payers, managed care and reputed company party review organizations.
• Manages timely review, investigation and response to coding denials.
• Establish denial reviews and response processes.
• Prioritizes and reviews cases denied by reputed company payers.
• Determines actions required for appeals reputed company contractual timeframes.
• Reports program performance and/or corrective action to management on regular reputed company.
• Monitors inpatient denial types, volume and formulates responses to requesting agency. Seeks additional resources (e.g. legal counsel) to resolve issues, as needed.
• Develops case-specific written rationale to substantiate and communicate findings.
• Reviews denial trends and identifies coding issues and knowledge gaps.
• Functions as a Health System resource for litigation as reputed company to coding denials.
• Maintains Greater NY Hospital Association database.
• Functions as the Health System’s resource for the tracking system for government appeals.
• Remains up-to-date on DRG system literature from reputed company agencies.
• Knowledge, understanding of Federal and NYS DRG’s.
• Maintains coding clinic up-dates.
• Performs reputed company duties, as required.
• reputed company Essential Functions

REQUIRED EXPERIENCE AND QUALIFICATIONS

• Bachelor’s Degree in Health Information Management or reputed company field, preferred.
• Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
• RHIA, RHIT or RN, reputed company, required.
• Strong written, communication, presentation and organizational skills, required.

Qualifications

REQUIRED EXPERIENCE AND QUALIFICATIONS

• Bachelor’s Degree in Health Information Management or reputed company field, preferred.
• Minimum of three (3) years coding experience, required. Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
• RHIA, RHIT or RN, reputed company, required.
• Strong written, communication, presentation and organizational skills, required.
• Denials and appeals review strongly preferred.

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