Ovation Healthcare
healthcare
Coder,Edits/Denials
“Coder, Edits/ Denials at Ovation Healthcare. Skills: coding, appeal investigating payer issues, completing charge corrections, timely filing of appeals to insurance companies. review medical records to determine appropriate billing codes and necessary documentation. performing advanced coding and appeal investigating payer issues”
What You'll Achieve.
meet and maintain a 95% quality accuracy rate and productivity standards
Industry & Context.
Investigates and problem-solves reimbursement issues
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
What They're Looking For.
Must Have
ICD-10 and CPT Coding, comfortable working with AR teams to resolve issues, able to pass a coding assessment, meet and maintain a 95% quality accuracy rate and productivity standards, able to apply official coding guidelines, NCCI edits, CPT Assistants, and Coding Clinics, experience working in a remote environment
Nice to Have
CCS, AHIMA, CCS-P, CPC, AAPC, CPC-A, or AAPC Credentials
What You'll Do.
review medical records to determine appropriate billing codes and necessary documentation
performing advanced coding and appeal investigating payer issues
completing charge corrections
timely filing of appeals to insurance companies
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
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
reviews remittance advice for rejections and accuracy of payment amounts as needed
Identifies invoices or claims that have been rejected per billing edits/criteria
How You'll Work.
Team & Collaboration
comfortable working with AR teams to resolve issues; collaboration with other coding staff and faculty; Works directly with facility liaison or other clinical staff as needed
Communication Scope
excellent communication skills
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