Denials Specialist

Responsibilities:

• Review the provider's documentation to ensure all diagnoses and procedure codes were reported accurately.
• Research CMS LCD, NCD, NCCI Edit Policy, CPT Assistant, HCPCS Coding Clinics, payer guidelines, etc.
• Complete charge corrections and update claims when coding corrections are needed.
• Identify claims that do not support billed CPT codes and take action as needed.
• Identify and resolve claims requiring adjustments by updating the billed E/M and procedure codes with a non-billable charge code.
• Identify trends and provide feedback to prevent future denials.

Qualifications

• Professional coding certification such as CPC, CCS, CIC, or COC and 1 year of experience in a coding-related denials management role.
• Experience with complex surgical specialties and interventional radiology (IR) is a plus but not required.
• Familiarity with Athena is preferred.
• Experience with a variety of denial types including medical necessity, timely filing, incorrect modifier usage, and unbundling of procedure codes.
• Strong working knowledge of
  • CPT®, HCPCS, ICD-10-CM/PCS
  • Modifiers and NCCI edits
  • Medicare and commercial payer billing rules
• Strong attention to detail and strong analytical skills.
• Knowledge of payer contracts and reimbursement methodologies.

UASI provides a supportive environment that encourages professional development and enables each employee to achieve their individual goals. We offer a competitive pay and excellent benefit package.