Job title: Clinical Coding Denial Specialist
Company: University of Chicago Hospital
Job description: Job DescriptionBe a part of a world-class academic health-care system at UChicago Medicine as a Clinical Coding Denial Specialist in the Medical Records department. This is a remote, work from home opportunity and you may be based outside of the greater Chicagoland area.In this role, the Clinical Coding Denial Specialist, under general direction, is responsible for actively managing, maintaining, and communicating third party denial/appeal activity as it relates to facility coding and documentation. This role is key to securing reimbursement and minimizing lost revenue for the health system.Essential Job Functions
- Maintains active stewardship of the denial process
- Receives denials and identifies those cases that warrant an appeal
- Evaluates denials to ensure compliance with payer or government rules/regulations to determine appropriateness for appeal
- Prioritize denial appeals in adherence with auditing company or insurance carrier timelines
- Secures and distributes needed medical record documentation required/requested by auditing companies or insurance carriers to support the appeals process
- Constructs, and submits, professionally written appeals utilizing compelling and organized arguments based on coding guidelines, clinical documentation, third-party payer medical policies, and UCM policies/procedures as well as guidelines established by professional organizations
- Assumes ownership of appeals throughout the entire process, including second level appeals and escalations
- Responsible for updating the status of denials using the denial tracking software
- Disseminates denial-related data
- Identifies and analyzes denial trends to realize areas of education for stakeholders, e.g., HIM Coding/CDI staff and clinicians
- Develops educational presentation/training materials regarding denial trends and avoidance of future denials
- Creates monthly, quarterly, and annual reports on denial volume and outcomes to share with HIM leadership
- Nurtures productive collaboration with other departments and clinicians to support the appeal process
- Proactively maintains an up-to-date awareness of changes to coding guidelines and clinical definitions
- Maintains certification(s) in accordance with relevant professional organization guidelines, i.e., American Health Information Management Association (AHIMA) or Association for Clinical Documentation Integrity Specialists (ACDIS)
- Demonstrates courtesy and professionalism through interaction, appearance, attitude, and written and oral communications with visitors, co-workers, physicians, and other hospital personnel
- Maintains patient confidentiality as required by Hospitals/departmental policy and industry/legal standards
- Acknowledges and supports Hospitals defined goals and approach to patient care; attends regular training sessions to improve patient and customer communications
- Keeps work area neat and clean; properly cares for equipment
- Performs other related tasks as may be deemed necessary for the effective and efficient function of coding, auditing, and denials
Required Qualifications
- Certification as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Clinical Documentation Specialist (CCDS), or Clinical Documentation Improvement Practitioner (CDIP)
- Bachelor’s degree in nursing, Health Information Management, or related field
- At least 5-10 years of experience in Hospital Coding, Denials Management, or Clinical Documentation Integrity
- Must have skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines
- Ability to work independently and be result oriented
- Excellent verbal and written communication skills
- Ability to impart knowledge of procedures and diagnoses in advanced appeal writing process
- Must have thorough working knowledge of ICD-10-CM, DRG, and CPT coding systems, and federal/state regulations regarding reimbursement
- Must have a thorough working knowledge of the hospital information system, electronic medical record systems and encoder
- Must have working knowledge of standards for chart completion
- Must have a working knowledge of medical-legal rules and regulations that govern the confidentiality and release of medical information with the ability to interpret and implement the standards
- Must maintain total confidentiality of all patient records
- Strong computer skills including high proficiency with Microsoft Office Suite
Position Details
- Job Type/FTE: Full-Time
- Shift: Days
- Work Location: Remote
- Unit/Department: Health Information Management
- CBA Code: Non-union
Why Join UsWe’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: .UChicago Medicine is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.
Expected salary:
Location: Chicago, IL
Job date: Wed, 01 Jan 2025 05:51:16 GMT
Apply for the job now!
