Denials Coder

Now hiring an Inpatient Denials Coder for a large healthcare system in Florida! This is a 100% Remote Position (candidates MUST live in Florida, North Carolina, Georgia, Alabama, Texas, Arizona).

Key Responsibilities:

• Research payer denials related to coding, documentation, referral, pre-authorization, notifications, medical necessity, non-covered services, and billing issues causing denials and delays in payment.
• Conduct comprehensive reviews of claim denials, account/guarantor notes, and medical records to determine:
• Whether a revised claim is necessary.
• Whether retro authorization is needed.
• Whether a written appeal should be submitted.
• If no further action is needed.
• Write and submit professionally crafted appeals based on:
• Clinical documentation.
• Third-party payer medical policies.
• Contract language.
• Ensure appeals are submitted in a timely manner and tracked for outcomes.
• Submit detailed, customized appeals to payers in accordance with medical records and guidelines for Medicare, Medicaid, and third-party payers and compliance policies.
• Collaborate with the prior authorization team to obtain retro-authorizations for authorization denials or anticipated denials.
• Identify denial patterns and escalate to management with sufficient details for further follow-up or resolution.
• Recommend changes to work queues and claim edits to improve efficiency and reduce denials.
• Review payer communications to identify potential risks for lost reimbursement due to medical policies and prior authorization requirements.
• Escalate potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as necessary.
• Identify opportunities for process improvements and actively participate in process improvement initiatives.

Systems: Epic and Optum

Certifications (1): CPC, CCS

Education: High School Diploma

Duration: Contract to Hire (contract set to run 6 months)

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.