Easter Seals Jobs

Performs advanced level work related to insurance denial management.Responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned.Conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is needed.Writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.Handles audit-related / compliance responsibilities and other administrative duties as required.Actively manages, maintains, and communicates denial/appeal activity to the RCM Director and reports suspected or emerging trends related to payer denials to Revenue Cycle management. Accounts for coding and abstracting of patient encounters, including procedural information, significant reportable elements, and complications.Researches and analyzes data needs for reimbursement.Analyzes medical records and identifies documentation deficiencies.Serves as resource and subject matter expert to other coding staff.Reviews and verifies documentation supporting diagnoses, procedures, and treatment results.Identifies diagnostic and procedural information.Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.Assigns codes for reimbursements, research, and compliance with regulatory requirements utilizing guidelines.Follows coding conventions. Serves as a coding consultant to care providers.Identifies discrepancies, potential quality of care, and billing issues.Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors.Identifies reportable elements, complications, and other procedures.Serves as resource and subject matter expert to other coding staff.Assists lead or supervisor in orienting training, and mentoring staff.Provides ongoing training to staff as needed.Handles special projects as requested.Proficient in Excel Sorting, Pivots, and VLOOKUPThis is not a Remote PositionEducation, Experience, and Licensing Requirements:High school diploma, GED, or equivalentUniversity/college degree, or experience medical records, claims or billing areas is an asset.CCA (AHIMA) CCS (AAPC) or greater