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Coder, Edit/Denials
Ovation HealthcareEdit & Denials Coder reviewing medical records to determine billing codes for Ovation Healthcare. Collaborating with clinical staff to resolve billing issues and developing appeals.
About the role
Key responsibilities & impact- Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse
- Creates appropriate letters to substantiate the validity of claims
- Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up
- Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty
- Works directly with facility liaison or other clinical staff as needed to provide documentation feedback and to develop appeals
- Researches payer policies and processes
- Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment
- Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed
- Identifies invoices or claims that have been rejected per billing edits/criteria
Requirements
What you’ll need- Knowledge of ICD-10 and CPT Coding
- Must be comfortable working with AR teams to resolve issues
- Must be able to pass a coding assessment
- Must be proficient in Microsoft Office, including Outlook, Excel, and Teams
- Ability to multi-task and have excellent communication skills
- Must meet and maintain a 95% quality accuracy rate and productivity standards
- Must be able to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics
- Must have experience working in a remote environment
- CCS, AHIMA, CCS-P, CPC, AAPC, CPC-A, or AAPC Credentials
- Three or more years of Coding experience
Benefits
Comp & perks- Reliable high-speed internet connection is required for all remote/hybrid positions
- HIPAA-compliant work environment
ATS Keywords
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Hard Skills & Tools
ICD-10 CodingCPT CodingCoding Guidelines ApplicationNCCI EditsCoding ClinicsRemittance Advice ReviewClaims Denial InvestigationDocumentation ReviewMulti-taskingQuality Accuracy Rate
Soft Skills
Excellent Communication SkillsProblem-solving
Certifications
CCSAHIMACCS-PCPCAAPCCPC-A