Coding Denial Specialist (Remote) - Health Support Center : Job Details

Coding Denial Specialist (Remote)

Schedule:

Days: M-F. Full time, 40hrs per week.

Work between 7am-6pm in your time zone. All US time zones are welcome to apply.

On occasion, schedule adjustment may be necessary for mandatory department meetings/project-based meetings to accommodate all time zones.

Job Location Type: Remote

Your experience matters

At Lifepoint Health, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier .

How you'll contribute

Coding Denial Specialist performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referrals, authorizations, notifications, non-coverage, medical necessity, and others as assigned. The Coding Denial Specialist conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a written appeal is needed, or if no action is needed. The Coding Denial Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through outcome. The incumbent will also handle audit-related / compliance responsibilities and other administrative duties as required.

A Coding Denial Specialist who excels in this role:

• Certified Pro-Fee with a minimum of 3-5 years' coding experience.
• Experience with Provider Based and Rural Health preferred.
• Manage time effectively to meet all required deadlines and timeframes for client and department needs.
• Collaborate in a team environment with the Department Manager and other staff on a regular basis.
• Ensure compliance with all relevant regulations, standards, and laws.
• Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
• Independently write professional appeal letters.
• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines.
• Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
• Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
• Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
• Claim corrections in a timely manner including portal corrections.
• Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.
• Identify opportunities for process improvement and actively participate in process improvement initiatives.
• Complete any coding and billing related denial as required by payer and system.

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.

• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.

• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.

• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).

• Professional Development: Ongoing learning and career advancement opportunities.

• Performance bonus eligible!

What we're looking for Education: High school diploma or equivalent required. Bachelor's Degree preferred or equivalent experience

Experience: 3-5 years medical coding denial experience

Certifications: Coding Certification through AHIMA or AAPC. (CPC, CEMC, CPMA, CRC, CPB, RCMS, Specialty certification, CCS-P, RHIT)

EEOC Statement

Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

You must be authorized to work in the United States without employer sponsorship.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.