Specialist, Coding Denials
Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat. Job Description:
Cancer care is all we do
Hope in healing
The Coding Specialist is responsible for review and resolution of professional coding denials, Critical responsibilities include:
- Handles day to day processing of professional coding denials/appeals. This includes investigating the reason of the denial, review of the coding on the claim and completing any changes needed or writing appeal letter, maintaining a record of action taken and monitoring the compliance time frame requirements from the various insurance plans.
- Demonstrates the ability to assess the accuracy of coding including modifiers of medical and surgical services in accordance with established criteria.
- Assists with identifying areas of denial trends and mitigation opportunities.
- Assists with data collections for accurate analysis and resolution of professional claims denials and tracking of root cause/trends.
- Works closely with departments outside of Clinical Appeals that impact denials when needed.
- Responsible for maintaining proficiency in all technology and applications.
- Responsible for maintaining and keeping current coding credentials.
- 45%| Accurately review denials to ensure ICD/CPT codes for each diagnosis and procedure are substantiated by documentation contained in the medical record following departmental and current official ICD/CPT coding guidelines.
- 20%| Analyze denials for appeal opportunities, complete appeal letter with supporting documentation and coding guidelines
- 10%| Utilize applicable resources such as CCI edits/ NCCI manual/ CPT assistant and coding clinics to make corrections when needed to denied claims to ensure consistent and accurate coding of diagnostic and procedural data.
- 10%| Analyze major insurance/ government payers reimbursement and medical policy guidelines and apply to denial root causes.
- 10%| Assist with education initiatives with Supervisor and other departments to resolve and mitigate denials.
- 5%| Analyze denials work queue (PIC) daily to prioritize daily work and denials tasks to meet the department key performance indicators.
Skills, Education and Additional Information
- Minimum 2-3 years of experience in Health Information Management and a Bachelor’s degree preferred.
- Registered Health Information Technician (RHIT), Certified professional Coder (CPC), or Certified Coding Specialist (CCS) certification required.
- Must have two to three (2-3) years of related medical coding experience in an acute care hospital setting.
- Thorough knowledge of CPT, ICD-10 and HCPCS systems.
- Knowledge of hospital billing systems for Government, managed care and commercial payers.
- Written and verbal communication ability with all clinicians and their staff professionally, succinctly, and authoritatively.
- Customer-service oriented, timely in responses to requests for service/information, able to manage multiple tasks and priorities, can work independently and possess leadership skills.
- Demonstrated knowledge of current ICD/CPT diagnosis and procedural coding.
- Previous experience developing and conducting physician and coding educational sessions and formal presentations beneficial.
- Prefer knowledge of the revenue cycle, charge master, manual coding assignment, encoding software revenue codes, and denials management.
- Knowledge of medical terminology, anatomy, and physiology
- Knowledge of cancer specialty medicine coding and reimbursement.
- Skill in both oral and written communication.
- Customer-service oriented, timely in responses to requests for service/information, able to manage
- Proficient in Microsoft Applications with knowledge of Microsoft Excel is preferred.
- Must be willing to travel, as needed.
Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. Visit: Jobs.cancercenter.com to begin your journey.
We win together
Visit: Jobs.cancercenter.com to begin your journey.