Edit & Denials Coder
Ovation Healthcare seeks an Edit & Denials Coder to review medical records to determine appropriate billing codes and necessary documentation. This role is responsible for performing advanced coding and appeal activities; investigating payer issues, completing charge corrections, and for timely filing of appeals to insurance companies.
Duties and Responsibilities:
- Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse. Creates appropriate letters to substantiate the validity of claims.
- Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up. Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty. Works directly with facility liaison or other clinical staff as needed to provide documentation feedback and to develop appeals.
- Researches payer policies and processes.
- Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment.
- Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed. Identifies invoices or claims that have been rejected per billing edits/criteria.
Knowledge, Skills, and Abilities:
- Knowledge of ICD-10 and CPT Coding
- Must be comfortable working with AR teams to resolve issues.
- Must be able to pass a coding assessment.
- Must be proficient in Microsoft Office, including Outlook, Excel, and Teams.
- Ability to multi-task and have excellent communication skills.
- Must meet and maintain a 95% quality accuracy rate and productivity standards.
- Must be able to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics.
- Must have experience working in a remote environment.
Work Experience, Education, and Certifications:
- CCS, AHIMA, CCS-P, CPC, AAPC, CPC-A, or AAPC Credentials
- Three or more years of Coding experience
Working Conditions and Physical Requirements:
- Reliable high-speed internet connection is required for all remote/hybrid positions.
- Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.
- A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.