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Medical Coding Claim Edits/Denials Specialist



Job description

Job Description

At e4health, we Empower Better Health .

The e4health Team is on a relentless mission to care for those teams who care for others.

We bring our passion, ingenuity, and expertise to every engagement.

In joining our Team, we want your help to provide our customers with powerful solutions in the pursuit of quality, integrity, clinical and financial value across healthcare.

Our People make the difference.

Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise.

e4health solutions streamline clinical, financial, and health information data and workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country.

Learn more about us at .

Medical Coding Claim Edits/Denials Specialist - Remote

Job Summary:

The Medical Coding Edit Specialist position is responsible for resolving coding account edits of multiple patient types prior to billing.

These types of edits may contain NCCI, OCE, Medical Necessity LDC/NCD and diagnosis code rejections.

Other types of edits may be included.

Responsibilities will include assigning and/or correcting codes and modifiers with ICD-10-CM, CPT and HCPCS Level II Codes as appropriate from the documentation within the electronic medical record.

The Coding Edit Specialist is expected to maintain consistent accuracy rate of 95% or better while also meeting agreed upon productivity standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

  • Reconcile held accounts by resolving the edit and dropping the account.
  • Responsible for all account edits from various payors and vendors.
  • Identify and report major edit issues
  • Provide remote coding edit and denial resolution services
  • The Coder(s) will review the medical records and resolve identified coding edits to expedite billing of the encounters
  • The Coder(s) will apply the appropriate code sets per the Client ’s coding guidelines and in accordance with the AHIMA and CMS Standards for Ethical Coding
  • eCatalyst Coder(s) will review denials for correct coding as per medical record documentation
  • If appropriate for appeal, Coder(s) will use Client templates to draft appeal responses, or create templates as requested by Client
  • Assist in identifying problems and resolution thereof.

    Identify opportunities to reduce coding edits by providing proactive education
  • Communicates quality issues to management as appropriate.

    Notifies management when there is a compliance concern or incident
  • Demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
  • Promotes confidentiality and using discretion when handling patient information
  • Attends educational conference calls
  • Provides additional support to the business as needed
  • Maintains required productivity and quality requirements
  • Maintains coding credential requirements
  • REQUIRED QUALIFICATIONS:

  • Candidate must possess an approved AHIMA or AAPC coding credential
  • Minimum 2 years’ coding experience preferred
  • Must have up to date knowledge of third-party rules and regulations
  • Specific client systems experience may be preferred as per client needs

  • Required Skill Profession

    Health Technologists And Technicians



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