Coding Appeal Specialist

Remote, CA 90802

Job Number: 2644

Job Description


CODING APPEAL SPECIALIST – MANAGED RESOURCES

Part-Time | Remote| Permanent

Job Overview/Purpose

The Coding Appeal Specialist reviews and analyzes denied/downgraded MS-DRG, APR-DRG and APC accounts received from all types of payers (e.g., Medicare, Commercial, and Third Party). Utilizing coding expertise, the Appeal Specialist will render determination on whether the denied/downgraded account is appealable based on the standards of each client. After review of the denial and medical record, the Coding Appeal Specialist will provide either a reasoned explanation why no appeal can be written, or a detailed appeal letter based on current coding and regulatory guidelines. In either case the Coding Appeal Specialist will then track, and trend MRI defined denial root causes for each specific denial.

Founded in 1994 Managed Resources (MRI) in Long Beach California, MRI partners with clients nationwide to help them solve complex revenue cycle and compliance challenges.  In our over 25 years of operations, MRI has had the pleasure of working with many of the most prestigious healthcare organizations and medical groups in the county that span from the Hawaiian Islands to the East Coast.  

Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources.

DESCRIPTION

Complete the following functions in accordance with Managed Resources policies:

Perform efficient analysis of denied claims, pinpointing reason for denial and potential for success of appeal including correct allocation of diagnostic and procedural codes under:
  • ICD-10 Official Coding Guidelines and ICD-10 Procedural Coding Guidelines
  • 3M APR-DRG Classification System
  • CPT
  • HCPCS
  • Revenue Code
  • All associated authorities such as CMS regulations, statutes, and associated authorities such as AHA Coding Clinics and CPT Assistant

When the decision is made to appeal:
  • Write clear and concise grammatically correct appeals letter in MRI format and to MRI quality standards
  • Be aware of the level of appeal, level of future appeals available and write according to the level of appeal
  • Utilize current applicable coding standards
  • Understand and strictly comply with time deadlines; write appeals in an efficient and timely manner
  • Provide a reasoned root cause analysis and summary review for all clients within MRI standard
  • At all times observe all HIPAA standards
  • Obtain and maintain client computer accesses
  • Participate in preparation of clear and concise audit report, as needed
  • Stay current in coding and appeal writing areas and comply with MRI quality recommendations to maintain efficient and effective processes
  • Identify coding and clinical documentation issues and provide proactive recommendations through manager to clients
  • Identify problem account and seek review or return to client through manager, as appropriate
  • Clearly and concisely update patient account record to identify actions taken on account

CERTIFICATIONS
  • CCS, CPC, or RHIT Certification is required

QUALIFICATIONS

Ideal candidate will possess the following:

 
  • 5+ years of experience in Hospital inpatient and/or outpatient coding
  • 2+ years of denials writing experience
  • Experience reviewing and analyzing denied/downgraded MS-DRG, APR-DRG, and APC medical records and accounts received from payers (e.g., Medicare, Commercial, and Third Party)
  • Experience in a variety of Electronic Medical Records (EMR) Systems, i.e. (3M, Nuance, Epic, etc.)
  • Excellent verbal and written communication skills
  • Excellent computer skills (Word, Excel, Skype, Dual Screens, etc.)
  • Excellent organizational and time management skills with a strong focus on detail and the ability to work remotely in an environment where HIPAA regulations can be enforced

 

Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

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