Coding Denials Specialist

Coding Denials Specialist

Ventra Health is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary

The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work queues. This role is responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution.

Essential Functions And Tasks

• Processes accounts that meet coding denial management criteria, including rejections, down codes, bundling issues, modifiers, level of service, and other assigned queues.
• Resolves work queues according to prescribed priority and/or per management direction, adhering to policies, procedures, and job aids.
• Validates denial reasons and ensures coding accuracy.
• Generates appeals based on dispute reasons and contract terms specific to the payor, including online reconsiderations.
• Follows specific payer guidelines for appeals submission.
• Escalates exhausted appeal efforts for resolution.
• Adheres to departmental production and quality standards.
• Completes special projects as assigned by management.
• Maintains working knowledge of workflow, systems, and tools used in the department.

Education And Experience Requirements

• High school diploma or equivalent required.
• One to three years of experience in physician medical billing with an emphasis on research and claim denials.
• Current AAPC or AHIMA certification required.

Knowledge, Skills, And Abilities

• Knowledge of health insurance, including coding.
• Thorough knowledge of physician billing policies and procedures.
• Thorough knowledge of healthcare reimbursement guidelines.
• Knowledge of AHA Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10-CM and CPT coding.
• Computer literate; working knowledge of Excel is helpful.
• Ability to work in a fast-paced environment.
• Good organizational and analytical skills.
• Ability to work independently.
• Ability to communicate effectively and efficiently.
• Proficient computer skills, with the ability to learn applicable internal systems.
• Ability to work collaboratively with others toward shared goals.
• Basic use of computer, telephone, internet, copier, fax, and scanner.
• Basic touch 10-key skills.
• Basic Math skills.
• Understand and comply with company policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Compensation

Base Compensation will be based on various factors unique to each candidate, including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Key skills/competency

• Coding Denials Specialist
• Revenue Cycle Management
• Medical Billing
• Claim Resolution
• Appeals Submission
• Medical Coding
• ICD-10-CM
• CPT Coding
• Healthcare Reimbursement
• AAPC/AHIMA Certification