Thorough knowledge of medical terminology, anatomy & physiology and pathophysiology
Extensive understanding of Coding guidelines, CCI edits, CPT, HCPCS, ICD, UB-04 Revenue Codes, modifiers, billing, regulations and guidelines
Ability to read medical charts or dictation, understand services performed, and correlate those services to charges on the bill
Proficiency in Microsoft Suite applications specifically Excel, Word and Outlook
Strong critical thinking and problem-solving skills with ability to multi-task or reprioritize quickly
Technical proficiency within Patient Accounting system and applicable vendor technologies; position requires ability to navigate various modules within applicable technologies to perform account research
Self-starter with the ability to work under limited day-to-day oversight in a remote setting
Ability to educate others regarding coding guidelines
Ability to maintain required productivity and accuracy standards
What You Will Need:
At least one year experience working payer denials for medical necessity, SSI and NCCI edits, incorrect procedure/diagnosis coding
At least five years recent acute care coding experience to include; Inpatient, ED, ancillary, observation, outpatient, and surgery coding.
Experience with HCPCS codes and resolution of OCE edits, SSI edits and CCI edits
Familiarity of the DRG reimbursement system
Medical Necessity and DRG appeal writing experience
Coding Audit experience
High school diploma or equivalent
RHIA, RHIT, CPC, or CCS certification or credential
The Denials Management Coding Specialist is responsible for investigating and resolving coding related denials from payers, preventing lost reimbursement and promoting denial prevention. The Denials Management Coding Specialist addresses both Inpatient and Outpatient claims and serves as a resource for all coding related questions and guidance to the Centralized Denial Team. The Denials Management Coding Specialist will adhere to the AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.