To enhance the health and well-being of every person we serve.
Physician Coding Denials Specialist
Location
United States
Posted
5 days ago
Salary
Not specified
No structured requirement data.
Job Description
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
OverviewThe Physician Coding Denials Specialist is responsible for reviewing and appealing coding denials for all assigned professional service claims related to Evaluation and Management coding. Closely works with Charge Coding & Revenue Management leaders and Account Resolution teams to provide feedback to providers/practices to improve clinical documentation and facilitate ongoing documentation improvement. Responsible for performing appeals for the Wellstar MGBO for professional services as deemed necessary. Monitor's denial work queues within Epic (Electronic Health Record) to ensure timely appeal deadlines are met. Must ensure timely, accurate and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials. Uses analytical skills to identify trends in payer denials and translates this information into Charge Review edits that will be used to prevent future denials. Assists in development and implementation of training for charge capture specialists.
Responsibilities
Core Responsibilites and Essential Functions
* Identify major reasons for denials root causes (Diagnosis, procedure codes, etc.)
* Work collaboratively with charge coding and revenue management to provide coding and documentation feedback to practices/providers.
* Utilize Epic to review account denial audits and perform trend analyses to identify patterns and variations in coding denials and practices.
* Maintain open communication with Wellstar Medical Group providers and practices to facilitate denial/appeals process.
* Review clinical records to identify overcharges, undercharges or charges that necessitate additional documentation.
* Research and analyze charge and coding requirements for new services and technology.
* Consistently meet current productivity and quality standards as assigned by department manager in ensuring accurate account follow-up.
* Identify opportunities for system and process improvement and submit to management.
* Working with MGBO Edit Committee, physician coding compliance and Epic Connect, translate identified trends into Epic charge review rules.
* Evaluates and adheres to clinical and billing policies, guidelines, and regulations of both commercial and governmental payors.
* Appeals denials or instructs the resubmission of claims based on compliant medical record documentation and Wellstar Medical Group/MGBO policies and procedures.
* Asses need for formal appeals of all clinical denials including but not limited to preauthorization of practice encounters and procedures, and for retroactive recovery reviews regarding medical necessity and limited billing compliance.
* Communicate with all internal contacts in a professional manner including providers, practice staff, co-workers, management, and clinical staff.
* Communicate with all external contacts in a professional manner including representatives from third party payor organizations.
* Interact with internal customers/departments including HIM, Charge Coding and Revenue Management, Patient Access and the Single Business Office in a professional manner to achieve revenue cycle department accounts receivable goals and objectives.
* Assure patient privacy and confidentiality as appropriate or required.
* Initiate communication with peers about changes in payor policies and internal policies and procedures.
* Prepare appeal letters that are specific, concise, and conclusive; providing payors with appropriate clinical documentation as needed.
* Provide feedback to physicians, providers and management in a timely and professional manner.
* Follow department guidelines for lunch, breaks, requesting time off, and shift assignments.
* Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices.
* Follow the health system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures.
* Follow JCAHO and outside regulatory agencies’ mandated rules and procedures.
* Participate in the testing for assigned software applications, including verification of field integrity.
* Perform other duties and responsibilities as assigned.
Required for All Jobs
Qualifications
Required Minimum Education
Required Minimum Experience
Required
Required Minimum Skills
Required Minimum License(s) and Certification(s)
Additional Licenses and Certifications
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
Related Guides
Related Categories
Related Job Pages
More Medical Billing and Coding Jobs
The Coding Compliance Specialist oversees and evaluates assigned Risk Adjustment Data Validation (RADV) medical record review work to ensure adherence to CMS RADV guidelines and coding standards. Key duties include providing expert guidance, reviewing escalated cases, maintaining quality assurance, and developing training programs.
RCM Training & Workflow Associate
Privia HealthPrivia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
The associate is responsible for delivering comprehensive virtual athenaOne Collector/Billing training to Care Centers during implementation and post-live phases, while also triaging stakeholder issues and ensuring training aligns with best practices. This role involves actively seeking feedback to continually elevate the Revenue Cycle Management and training program to a best-in-class standard.
Inpatient Coding Specialist
Lifepoint HealthLifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country. We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
Assign diagnosis and procedure codes using the appropriate coding classification system on all episodes of care inpatient encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure the accuracy of the information an...
The specialist will be responsible for submitting clean, accurate claims across medical, dental, and anesthesia services, and managing the resolution of denied, rejected, or underpaid claims, including appeals and payer follow-up. Key duties involve reviewing remittance advice to identify denial trends and ensuring work aligns with defined revenue cycle KPIs.
