Job Description:DHR Health - US:TX:Edinburg - DaysSummary:FLSA STATUS: ☐ Exempt ☒ Non-ExemptMISSION STATEMENT:Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.VISION:Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.POSITION SUMMARY:The Coder Denials Specialist reviews and resolves claim denials related to coding errors, ensuring accurate billing and reimbursement in healthcare. This role involves analyzing denial trends, researching coding issues, submitting corrected claims or appeals, and collaborating with other departments to improve documentation and coding practices. In essence, the Coder Denials Specialist acts as a detective, problem-solver, and educator within the denials department and revenue cycle.POSITION EDUCATION/ QUALIFICATIONS:· Coding credential from an accredited coding organization required· Credentials from AHIMA, AAPC preferred· Extensive knowledge of medical terminology· Knowledge of Coding Guidelines· Knowledge of CPT rules and regulations· Knowledge of NCCI policies· Knowledge of Professional Billing· Highly reliable· Must be a team player with good people skills and possess strong initiative to get daily work finished and processed· Maintain productivity levelsJOB KNOWLEDGE/EXPERIENCE:· Extensive experience in medical coding, medical terminology, and anatomy and physiology required; 3 year of coding experience preferred· Requires reasoning ability and good independent judgment· Ability to perform productive research quickly· Requires working with minimal interruptions· Must have an understanding of laws and ethics related to health insurance, medical billing and Health insurance Portability and Accountability Act (HIPPA)· Computer and coding software experience required, 3M encoder preferred· Advanced computer skills required with knowledge of Microsoft Office suite· Experience in Professional coding and billing a plusResponsibilities:POSITION RESPONSIBILITIES:· Reviewing Denials:· Analyzing claim denials related to coding errors, such as incorrect ICD-10, CPT, or HCPCS codes, missing modifiers, or bundling issues.· Researching and Correcting Codes: Investigating the reasons for denials and researching the appropriate codes to use, adhering to payer guidelines, and National Coding Standards.· Submitting Appeals: Preparing and submitting appeals to payers with supporting documentation and compelling arguments based on clinical documentation and relevant policies.· Collaborating with Teams: Working with providers, coders, and other revenue cycle staff to clarify documentation and improve coding accuracy.· Analyzing Trends: Identifying patterns in denials and working with teams to implement preventative measures.· Staying Updated: Keeping abreast of payer policies, coding updates, and regulatory changesLINES OF REPSONSIBILITIES:(Chain-of-command)1. Denials Supervisor → 2. Director of Coding & Denials Mgmt → 3. Physician Advisor → 4. Chief Financial OfficerOther information:CUSTOMER SERVICE:Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.AGE SPECIFIC:Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.AMERICANS WITH DISABILITIES ACT: (ADA):A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.The following table provides physical requirements that will be associated with, but not limited to, this position:Light/moderate lifting up to 20 lbs, from the floor to shoulder height.YesKneelingYesMust be able to assist other employees with lifting more than 20 lbs.YesWalkingYesLight/moderate carrying up to 20 lbs.YesStanding/SquattingYesStraight pullingYesSittingYesPulling hand over handYesPushingYesRepeated bendingYesStooping/BendingYesReaching above shoulderYesClimbing StairsYesSimple graspingYesClimbing LaddersNoDual simultaneous graspingYesDepth Perceptions neededYesAbility to seeYesIdentify ColorsYesOperating office equipmentYesTwistingYesOperating mechanical equipmentYesCrawlingNoAbility to read and writeYesAbility to CountYesAbility to hear verbal communication without aidYesOperating Personal VehicleYesAbility to comprehend written/verbal communicationYesOther: Ability to deal with stressYesOSHA CategoryIIIB. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.D. Aptitudes: HIGH 1 2 3 4 5 6 LOWIntelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3Numerical: Ability to perform arithmetic operations quickly and accurately. 2Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.If applicable certification will be completed within time frame of hire/transfer date.Employee Signature: Date: Transfer/Hire Date Effective: .
