Coding - Denials and Appeals

Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services.

1. Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion.

2. Review medical records to ensure billing is consistent with medical record for appeals, adjustments and miscellaneous/unlisted code review.

3. Works with DRGs and APR-DRGs.

4. Abstracts clinical data from these same patient records and performs data entry into clinical/statistical database.

5. Processes and maintains accurate hospital statistics.

6. Reviews EPIC work queues daily for coding edits and makes necessary and appropriate coding changes based on medical documentation.

7. Conducts reviews for appeals from payor denials.

Education and Experience

1. Education: Associate’s degree in Health Information or related field is required; Bachelor’s degree is preferred.

2. Certification: RHIT, RHIA, CCS

3. Years of relevant experience: 1 year required. 3 to 5 years is preferred.