|Employer:||Baylor Scott and White Health
|Required Certifications:||Certified Coding Specialist
|Required Experience:||3 to 4 years
The Denial Resource Center (DRC) Coding Specialist is responsible for supporting Baylor Scott & White Health (BSWH) denial management functions. The DRC is responsible for receiving claim denials and appealing to payors to promote appropriate reimbursement from payors to BSWH hospitals; manage denials; assist in appealing other types of denials in which coding expertise is beneficial; and serve as a resource for the DRC staff related to coding issues.
The Denial Resource Center (DRC) Coding Specialist receives denied claims primarily related to coding and/or DRG denials from the BSWH Central Business Office or from the payor and appeals the denied claim; review denied patient’s medical record; and review records that may assist with the appeal process. The Specialist must be knowledgeable of commercial and government regulations; engage the attending and consulting physicians as well as the Care Coordination Medical Directors; perform chart analysis on quality surveillance and special studies; identifies opportunities for and participates in process improvement and denial trends by DRG, type, procedure, etc. The Denial Resource Center (DRC) Coding Specialist assists leadership in developing the medical necessity documentation form to meet regulatory requirements; participates in pertinent meetings; documents denial information and appeal findings into the DRC electronic system for analysis of denial trends and appeal outcomes; and maintains credentials through completion of annual CEU requirement.
The ideal Denial Resource Center (DRC) Coding Specialist candidate is able to analyze documentation of clinical care and financial statements to determine best appeal strategy; knowledge of Joint Commission standards and CMS Conditions of Participation; written communication skills; critical thinking and analysis skills; and knowledge and effective use of various databases/systems to communicate and track status of appeal. The ideal candidate is able to develop and present information to various audiences and has expert knowledge of Coding Guidelines, ICD-10, CPT, etc.
§ Location/Facility – Bryan Tower at Dallas (for Orientation and Training) / Remote
For more information on the facility, please click our Locations link.
§ Specialty/Department/Practice – Denial Resource Center
§ Shift/Schedule – Full Time, Days
§ Benefits – Our competitive benefits package includes*:
ü Immediate eligibility for health and welfare benefits
ü 401(k) savings plan with dollar-for-dollar match up to 5%
ü Tuition Reimbursement
ü PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.