Coding Appeals Specialist

Thank you for considering a career at Ensemble Health Partners!Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups.
They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.Ensemble keeps communities healthy by keeping hospitals healthy.
We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful.
This is why our people are the most important part of who we are.
By empowering them to challenge the status quo, we know they will be the difference.The Opportunity:
THE CAREER POTENTIAL There is no limit to the experiences, opportunities, and new directions you will have access to here at Ensemble Health Partners.
More importantly, you will be driving the surge in a whole new direction in healthcare.
That's something we can all take pride in as we take this journey together.
Ensemble Health Partners are a leading innovator in revenue cycle management and have been awarded the 2022 "Best in KLAS" designation for full revenue cycle outsourcing for the third year in a row, receiving the highest score in Ensemble's history.
This designation recognizes that out of all the companies reviewed that offer full revenue cycle outsourcing, Ensemble was ranked number one by healthcare leaders around the country for its excellence in improving financial outcomes and patient experiences THE OPPORTUNITY The Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities.
Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns.
Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for outpatient coding and inpatient Diagnosis Related Group, (DRG) denials in order to support the assigned DRG and to address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes.
Essential Job Objectives:
The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals activities.
Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concernsCode medical records and write denial lettersParticipates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriateMaintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues.
Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to clientAssist in the development and coordination of the executive summary reports, education and training client coding companion as it relates to the outcomes of the coding appealsMeet established productivity standards for coding appeals & coding certification requirementAttends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulationsProvides excellent customer service, in an organized and efficient manner, while maintaining a positive attitudeExperience We Love:
Knowledge of appeals concepts and principlesAdvanced knowledge of medical coding and billing systems, documentation, and regulatory requirementsAbility to use independent judgement and to manage and impart confidential informationAbility to analyzeStrong written communication and interpersonal skillsKnowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentationKnowledge of current and developing issues and trends in medical coding procedures requirementsAbility to clearly communicate medical information to professional practitioners and/or the general publicAbility to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirementsAbility to provide guidance and training to professional and technical staff in area of expertise.Ability to flex work schedule on an as needed basis to meet the business needs.Education/Certification(s):
HS Diploma or GED required, or associate degree/Bachelor's Degree preferred.Active Coding Certification (i.e.
RHIA, RHIT, CCS, CIC, CPC, COC, etc.)The #EnsembleDifference speaks for itself:
Three-time winner of "Best in Klas" 2020-2022Top Workplace USA Award (Nationally 2022)Top Workplace Innovation Award (Nationally 2022)Top Workplace Work-Life Flexibility Award (Nationally 2022)Top Workplace Leadership Award (Nationally 2022)Top Workplace Purpose and Values Award (Nationally 2022) .
@communitybrands.comBottom line, we believe in empowering people and giving them the tools and resources needed to thrive.
A few of those include:
Competitive compensation and benefits packages that reflect our commitment to providing fair and just workplaces.Wellness programming is designed to help our associates enhance their health, including a comprehensive annual health risk assessment.A culture truly participatory and to strengthen diversity and inclusion.Growth - Once you've joined our team, you will discover a variety of traditional and online learning opportunities, including tuition reimbursement, to help you acquire new skills and obtain degrees, certifications and CEUs.
And our managers will coach you toward greater success.Recognition - We recognize our associates through programs that include service awards, celebrations, and personal appreciation.
We also survey associates annually to assess their satisfaction with our organization and managers, and to identify areas for improvement.Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.
If you require accommodation in the application process, please contact our Human Resources Department at 877-#-# or .
@ensemblehp.com.
This department will make sure you get connected to a Human Resources representative that can assist you.
EEO is the Law FMLA Rights - English La FMLA Espa ol Join an award-winning companyThree-time winner of "Best in KLAS" 2020-#2 Top Workplaces Healthcare Industry Award2022 Top Workplaces USA Award2022 Top Workplaces Culture Excellence AwardsInnovationWork-Life FlexibilityLeadershipPurpose + ValuesBottom line, we believe in empowering people and giving them the tools and resources needed to thrive.
Benefit packages - We offer a variety of medical plans, retirement options, and 401k options.Wellness Programs - Are designed to help our associates enhance their health, including a comprehensive annual health risk assessment.Our Culture - Ensemble's Associate Engagement Committee facilitates fundraising, community outreach and DEI events throughout the year.Growth - We invest in your professional development.
Each associate receives a p.