We are seeking an experienced, certified medical/ surgical biller/ coder in Denial Management to report to our Morristown, NJ office. The Denial Management specialist will resolve Correct Coding Initiative (CCI) and Medically Unlikely Edits (MUE) received on facility services. Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies to bring timely resolution to issues.
Our Office: We are a growing pediatric neurosurgical and neurological practice seeking new talent to join our team! We offer our employees a comprehensive benefits package, 401k option, opportunity for bonuses, paid time off, paid Holidays, CEUs, company outings, Summer Fridays, and many more opportunities to grow your career.
Essential Duties and Responsibilities:
- Resolving Correct Coding Initiative (CCI) and Medically Unlikely Edit (MUE) coding related denials in accordance with established standards, guidelines and requirements.
- Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc.
- Apply and adhere to all correct coding principles, current CMS rules and coverage determinations, currently accepted compliance standards and all legal, federal and insurance regulations.
- Recognizes when additional assistance is needed to resolve coding issues and escalates appropriately and timely.
- Documents all actions taken in the EHR
- Resolves work queues according to the current practices polices and procedures, based on priority and/or per the direction of management.
- Identify issues/trends and communicates to management effectively to address and effect change
- Provides insight on effective procedures to streamline denial process
- Other duties as needed and assigned
Required Knowledge, Skills and Abilities:
- Experienced in EHR and RCM Applications. Knowledge with Athena a plus.
- 2+ years of Coding Denial Management and/or Medical Billing.
- 2+ years’ experience within a hospital or clinic environment.
- 2+ years of Interpretation of medical notes, operative reports and charge reports to identify proper billing and diagnosis codes.
- Fundamental understanding of Diagnosis-related groups (DRGs) and Revenue Codes.
- Must have thorough knowledge of ICD-10, CPT-4, and HCPCS coding.
- Knowledge of Medicare and other insurance carrier’s coding and compliance guidelines and policies.
- Proficient with MS Office; Word, Excel and Outlook.
- Excellent organizational and prioritization skills.
- Excellent verbal and written communication skills required; ability to communicate on all levels, fostering positive relationships to further align with the company’s goals.