Northwell Health
Great Neck, NY
Req Number 179272
Required: Must have Inpatient coding experience (minimum of 3 years' experience in Coding or Auditing).
Prefer Appeal writing experience a plus.
Highly Preferred: Auditing experience with DRGs.
Job Description
Responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Supports the review of denial trends and identifies coding issues and knowledge gaps.
Job Responsibility
Supports denial reviews and response processes; prioritizes and reviews cases denied by commercial payers.
Reports program performance and/or corrective action to management on regular basis.
Assists in monitoring inpatient denial types, volume and formulates responses to requesting agency; seeks additional resources (e.g. legal counsel) to resolve issues, as needed; develops case-specific written rationale to substantiate and communicate findings.
Addresses coding issues and knowledge gaps;...