Position Description

Performs coding and clinical denial reviews including, but not limited to precertification/medical necessity denials and appeals. Follows up on potential or post claim denials and is responsible for the investigation, interpretation and intervention with supporting efforts to secure appropriate payment of underpaid/denied claims. This may include communications with insurance carriers regarding medical record review/copy, drafting appeal letters and follow up and correspondence with payer and Managed Care until resolution.

Position Requirements

Associates Degree in Informatics or Health Sciences and 3 years or more of experience in Revenue Integrity, healthcare, coding, compliance or clincial field. Additional years of relevant work experience and/or other specialized training can be used in lieu of minimum education requirement. Coding or Revenue Integrity certification within 18 months of hire (AAPC-CPC or AHIMA-CCS). Knowledge of third-party billing regulations for hospital and/or provider reimbursement. Experience with CPT coding system. Knowledge of medical necessity edits related to (LCD/NCD/MUE/CCI). Strong clinical knowledge. Excellent verbal/written communication and critical thinking skills.

Preferred Requirements

5 years or more of experience in government and commercial insurances/ claims system reimbursement processes. CPC, CPMA, COC, CBP. RN license.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.