CORPORATE
Job Description POSITION SUMMARY Reviews and responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process.
Reviews denial trends and identifies coding issues and knowledge gaps.
Collaborates on operational performance and department quality improvement activates and committees.
RESPONSIBILITIES Liaise between the RAC, commercial payers, managed care and third party review organizations.
Manages timely review, investigation and response to coding denials.
Establish denial reviews and response processes.
Prioritizes and reviews cases denied by commercial payers.
Determines actions required for appeals within contractual timeframes.
Reports program performance and/or corrective action to management on regular basis.
Monitors inpatient denial types, volume and formulates responses to requesting agency.
Seeks additional resources (e.
g.
legal counsel) to resolve issues, as needed.
Develops case-specific written rationale to substantiate and communicate findings.
Reviews denial trends and identifies coding issues and knowledge gaps.
Functions as a Health System resource for litigation as related to coding denials.
Maintains Greater NY Hospital Association database.
Functions as the Health System's resource for the tracking system for government appeals.
Remains up-to-date on DRG system literature from all agencies.
Knowledge, understanding of Federal and NYS DRG's.
Maintains coding clinic up-dates.
Performs related duties, as required.
ADA Essential FunctionsREQUIRED EXPERIENCE AND QUALIFICATIONS Bachelor's Degree in Health Information Management or related field, preferred.
Minimum of three (3) years coding experience, required.
Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
RHIA, RHIT or RN, CCS, required.
Strong written, communication, presentation and organizational skills, required.
QualificationsREQUIRED EXPERIENCE AND QUALIFICATIONS Bachelor's Degree in Health Information Management or related field, preferred.
Minimum of three (3) years coding experience, required.
Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
RHIA, RHIT or RN, CCS, required.
Strong written, communication, presentation and organizational skills, required.
Denials and appeals review strongly preferred.
About the Company:
CORPORATE.
Estimated Salary: $20 to $28 per hour based on qualifications.
Reviews denial trends and identifies coding issues and knowledge gaps.
Collaborates on operational performance and department quality improvement activates and committees.
RESPONSIBILITIES Liaise between the RAC, commercial payers, managed care and third party review organizations.
Manages timely review, investigation and response to coding denials.
Establish denial reviews and response processes.
Prioritizes and reviews cases denied by commercial payers.
Determines actions required for appeals within contractual timeframes.
Reports program performance and/or corrective action to management on regular basis.
Monitors inpatient denial types, volume and formulates responses to requesting agency.
Seeks additional resources (e.
g.
legal counsel) to resolve issues, as needed.
Develops case-specific written rationale to substantiate and communicate findings.
Reviews denial trends and identifies coding issues and knowledge gaps.
Functions as a Health System resource for litigation as related to coding denials.
Maintains Greater NY Hospital Association database.
Functions as the Health System's resource for the tracking system for government appeals.
Remains up-to-date on DRG system literature from all agencies.
Knowledge, understanding of Federal and NYS DRG's.
Maintains coding clinic up-dates.
Performs related duties, as required.
ADA Essential FunctionsREQUIRED EXPERIENCE AND QUALIFICATIONS Bachelor's Degree in Health Information Management or related field, preferred.
Minimum of three (3) years coding experience, required.
Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
RHIA, RHIT or RN, CCS, required.
Strong written, communication, presentation and organizational skills, required.
QualificationsREQUIRED EXPERIENCE AND QUALIFICATIONS Bachelor's Degree in Health Information Management or related field, preferred.
Minimum of three (3) years coding experience, required.
Two (2) years experience in Chart Review/Hospital Reimbursement and regulatory background.
RHIA, RHIT or RN, CCS, required.
Strong written, communication, presentation and organizational skills, required.
Denials and appeals review strongly preferred.
About the Company:
CORPORATE.
Estimated Salary: $20 to $28 per hour based on qualifications.
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