Guidehouse Coding Denials Specialist- Pro Fee in Albany, New York
Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit: www.guidehouse.com.
The Remote Coding Denials Specialist- Pro Fee must be proficient in working denials for multipsecialty coding,along with E&M coding for all places of services. Will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.
Demonstrates the ability to perform quality coding on ancillary charts and clinic charts.
Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing
Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards
Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility.
Ability to maintain average productivity standards
Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines
Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met.
Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility.
Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request
Responsible for coding or pending every chart placed in their queue within 24 hours.
It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard
Coders are responsible for checking the Guidehouse email system at least every two hours during coding session.
Coders must maintain their current professional credentials while working for Guidehouse
Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility
Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content
Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services
Communicates problems or coding principle discrepancies to their supervisor immediately.
Communication in emails should always be professional (reference e-mail policy).
Must hold the following credential: CPC
3 years physician coding experience with experience working claim edits and denials
3-5 years ICD-10 and CPT coding experience
Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding
Ability to analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue
Experience creating appeal letters as appropriate and communication with billing teams within Guide house or within a client organization
Must have experience working in systems such as EPIC, Cerner, Next Gen, Allscripts or other EHR
Excellent verbal and written communication skills
High level of accuracy and productivity
Abide by all client policies and procedures.
Abide by all Guide house policies and procedures.
Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service
HIPPA compliant work stations
Strong knowledge of Protected Health Information
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & VoluntarySupplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
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