Coder- Appeal Denial Specialist are responsible for resolution of patient account balances associated with insurance denials, answer incoming insurance and practice calls with the ability to explain charges, services and insurance billing questions.  Coder-ppeals Denial Specialist are also responsible for ensuring accuracy as well as verifying completed and precise medical record(s) for the interpretation of clinical documentation completed by the medical staff to correctly assign appropriate ICD10, CPT and/or HCPCS codes for professional coding.

• Responsible for various aspects of medical billing: claim creation, claim submission, payment posting for insurance, and patient balances. These denials and appeals are billed in the Net Health/Waystar system electronically. 
• Obtains supporting documentation, i.e., medical records, EOBs, Remits, Authorizations, referrals, etc., through our email applications, scanning system, Medicare remittance system, and payer portal systems..
•  Reviews, interprets, and applies contractual terms and identifies and/or applies contractual and administrative adjustments. 
• Monitor insurance denials by running reports and contacting insurance companies to resolve and recover denied claims.
• Monitors aging reports for timely follow-up on unpaid claims.
• Performs retroactive review of registration data to aid in the assurance of clean claim submittal.
• Accurately documents claim actions taken within patient account/claims.
• Serves as a resource for problem solving issues related to registration, demographic, and insurance errors.
• Works payer correspondence including support tickets, emails, and phone messages from internal and external contacts.
• Works collaboratively with, Operations Denial Team, Credentialing/Provider Enrollment, and Cash Posting team as well as coworkers, Supervisors, Managers, and practice staff to resolve claim and account issues.
• Assists Patient Accounts Team as needed with incoming and outgoing patient calls to resolve and collect on a patient statement.
• Maintain department processes and controls according to Professional Coding Standards, CMS Standards, HIPAA, OIG, and the State guidelines as well as national payor coding guidelines as they pertain to professional coding and reimbursement.
• Communicate with Director/Clinical and compliance team to ensure accuracy on all documentation and encounter forms.
• Complying with medical coding guidelines and HealthPro Heritage policies. Ensuring codes are accurately assigned and sequenced correctly in accordance with government and insurance regulations.
• Demonstrate understanding of National and Local Coverage Determinations as per MAC region.
• Ability to maintain the confidentiality of PHI as per HIPAA and HPH requirements.
• Exhibit sound knowledge of anatomy and physiology, medical terminology, surgical terminology, pharmacological terminology, patient care documentation terminology.
• Researching information in cases where the coding is complex or unusual. Disseminate information regarding new or updated codes and/or coding policies either by payer or through guidelines and regulations. 
• Demonstrate knowledge of the Revenue Cycle and the impact of coding decisions on revenue cycle.
• Reviewing and processing insurance denials, analyzing Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERA) forms to ensure insurance companies have properly paid for charges. Identifying denial trends and forwarding to AR Management for review.
• Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing.
• Maintain current credentials through continuing education CEU’s as per certification requirements.
• Other duties as assigned.

• Demonstrated coding (ICD-10-CM, CPT and HCPCS) expertise. Ability to pass post-interview coding test.
• Computer literacy of medical information systems, records management software, encoders.
• Good computing knowledge in Microsoft Outlook, Word, Excel, PowerPoint etc.
• Excellent communication and customer service skills, both verbal and written
• Understanding of third-party reimbursement rules and regulations. Medical Billing experience preferred.
• Outstanding organizational, detail oriented and time management skills.
• Ability to work independently as well as part of a team when necessary.
• Excellent typing and 10-key speed and accuracy.