Coding Quality Denials Specialist

Overview:

UnityPoint Health is hiring a Coding Denial Specialist! This position investigates, manages, and resolves denied claims utilizing internal policies and procedures, official coding guidelines, and regulatory guidance. If you have several years of professional coding experience and are looking for a remote role, we would love for you to apply! 

 

Hours: Monday-Friday 8am-4:30pm 

Location: Remote - applicants preferably reside within the UnityPoint Health footprint of Iowa, Illinois, or Wisconsin 

Why UnityPoint Health?:

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.  

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.  Here are just a few:      

• Expect paid time off, parental leave, 401K matching and an employee recognition program.   

• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.  

• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.   

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.   

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. 

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities:

Processing & Resolution of PB Coding Denials:

• Serves as a subject matter expert and resource for PB Coding Denials for internal and external stakeholders
• Validate procedural codes according to coding conventions defined by the American Medical Association’s CPT manual, CMS, including the National Correct Coding Initiative, Medicaid and other third-party payer policies as applicable
• Validates diagnosis code according to the ICD-10 Official Guidelines for Coding and Reporting
• Research and resolve coding denial related issues accordingly per established EPIC Follow Up Review Work Queue functionality
• Working knowledge of modifiers, CCI edits, HCPCS, LCD/NCDs and other applicable tools to ensure compliance with payer regulations
• Demonstrate initiative to improve quality and customer service by striving to exceed customer expectations
• Perform other duties as requested to facilitate the smooth and effective operations of the organization
• Working knowledge of modifiers, CCI edits, HCPCs, LCD/NCDs and other applicable tools to insure compliance with payer regulations

Process Improvement:

• Collection and/or analysis of coding-related data for training purposes or presentation as needed
• Collaborate with Clinical Auditors to identify opportunities for improvement and provide guidance/counsel to providers
• Use audit results to recommend areas of focus for educational purposes, in-service training, initiate processes changes, and to reduce organizational risks
• Collaborate with key stakeholders to provide the necessary training/education to the departments/service lines as well as providers
• Collaborates and communicates with coding management and/or staff on trends in coding denials

Qualifications:

Education:

• Required: High School diploma or GED 
• Required: Completion of nationally recognized coding program (AHIMA/AAPC)
• Preferred: Associates degree/completion of a two-year Health Information Technology Program

Experience: 

• Required: Three (3) years professional coding experience

Certifications/Licenses:

• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC)

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