Appeal Resolution Coder

Job description

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; functions as a organization resource for litigation as related to coding denials. - Maintains hospital database. - Remains up-to-date on DRG system literature from all agencies. - Maintains coding clinic up-dates. - Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action. - Performs related duties as required. All responsibilities noted here are considered essential f...