Denial Coordinator

Family Practice Center, PC has a full-time Denial Coordinator position now available in our Administrative office. 

Job Summary:

The Denial Coordinator (Medical Coder) is responsible for reviewing and resolving denied insurance claims within a primary care and physical therapy setting. This role requires a strong understanding of medical coding and billing practices, as well as a keen eye for detail and problem-solving skills. The ideal candidate will be able to effectively communicate with insurance payers, providers, and other relevant parties to ensure timely claim resolution and revenue maximization.

Essential Duties and Responsibilities:

• Denial Review and Analysis:
  • Review and analyze denied claims from various insurance payers.
  • Identify the reason for denial, such as incorrect coding, missing documentation, or authorization issues.
  • Prioritize denials based on urgency and potential financial impact.
• Claim Resubmission:
  • Correct and resubmit denied claims with appropriate documentation and coding.
  • Appeal denied claims to insurance payers, providing clear and concise explanations for reconsideration.
  • Follow up on appealed claims to ensure timely resolution.
• Medical Coding:
  • Assign accurate ICD-10-CM and CPT codes to medical services and procedures.
  • Ensure compliance with coding guidelines and regulations.
  • Review and verify the accuracy of coding performed by other staff members.
• Documentation Review:
  • Review medical records to ensure complete and accurate documentation.
  • Identify any missing or incomplete documentation that may impact claim reimbursement.
  • Work with providers to obtain necessary documentation for claim resubmission.
• Payer Relations:
  • Build and maintain positive relationships with insurance payers.
  • Effectively communicate with payers to resolve issues and expedite claim processing.
  • Stay informed about payer policies and procedures.
• Data Analysis and Reporting:
  • Track and analyze denial trends to identify potential issues and improvement opportunities.
  • Generate reports on denial rates, resolution times, and financial impact.
  • Utilize data analytics tools to identify patterns and trends.

Qualifications:

• Education: High school diploma or equivalent.
• Certification: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification required.  
• Experience: Minimum of 2 years of experience in medical coding and billing, preferably in a primary care and physical therapy setting.
• Knowledge and Skills:
  • Strong understanding of medical terminology, anatomy, and physiology.
  • In-depth knowledge of ICD-10-CM and CPT coding guidelines.
  • Proficiency in medical billing software and electronic health records (EHR) systems.
  • Excellent analytical and problem-solving skills.
  • Strong attention to detail and accuracy.
  • Effective communication and interpersonal skills.  
  • Ability to work independently and as part of a team.

Additional Requirements:

• Must be able to pass a background check.
• Must be able to comply with HIPAA regulations.

By fulfilling these responsibilities, the Denial Coordinator (Medical Coder) will contribute to the financial health of the organization by maximizing reimbursement and minimizing revenue loss due to denied claims.

If you are looking for an office setting, with full-time benefits including health, dental, vision, life, long-term disability, paid time off, sick time, holiday time, 401K and more, then send your resume in today!