Coding Denials Specialist
TMFHS Woodgate IV Bldg-38050
1315 Doctors Dr
Tyler, TX 75701
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This position shall perform the execution of financial, coding, billing compliance, appeals, operational and investigative reviews to ensure the reliability and integrity of information, compliance with policies and regulations, the safeguarding of assets, the economical and efficient use of resources, and established operational goals and objectives of CHRISTUS Trinity Clinic. Responsible for validating coding discrepancies for all assigned pre-billed rejections, and denied professional service claims. Provide feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement. Responsible for performing appeals for CTC for professional services as deemed necessary. Responsible for monitoring denial work queues within EPIC to ensure timely appeal deadlines are met. Must have the ability to understand and apply critical thinking skills to ascertain the root cause for the denial. Must ensure timely, accurate and thorough appeals for all accounts assigned. Participate and/or facilitate a denial management team using a multi-disciplinary approach with staff from the business Office, clinics and outpatient departments as deemed necessary. All team members are expected to be knowledgeable and compliant with CHRISTUS Trinity Clinic's values of compassion, dignity', excellence, integrity and teamwork.
Provide feedback to physicians and management in a timely and professional manner.
- Minimum requirements: Associate/Bachelor Degree in Business/Healthcare or 5-7 years of direct coding and denials experience
- 3-5 years of healthcare, clinical appeals/denials, coding, billing, CPT and HCPCS or combination of applicable experience and education; Or auditing experience preferred.
- Denials, Appeals, Coding, Billing and Follow-up
- Must be able to think analytically, independently, and objectively.
- Medical terminology and or anatomy/physiology, ICD-ICD-IO coding. Understanding Medicare compliance regulations
- Experience using multiple software resources, including excel, word, access, email and different types of websites. Graphs and data table experience
- Organizational and analytical skills. Proven communication skills. Extreme attention to detail with ability to prioritize assignments to meet deadlines.
- Proven communication skills and positive motivational skills.
- Must hold a current coding certification