Job description

Email me directly: landers@ intellisiq.com

Inpatient Denials and Appeals Specialist - Remote

Job Summary:

The Inpatient Denials and Appeals Specialist is responsible for completing quality assurance reviews on denied claims. This may include validation of clinical indicators for which coding was assigned, based upon the specific denial. If an appeal is warranted, Appeals and Denials specialist would write appeal to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient's medical record. Understanding of Official ICD-10-CM and ICD-10-PCS Guidelines for Coding, UHDDS guidelines, and CMS directives, along with appropriate Present on Admission (POA) indicators according to AHA POA guidelines. The Appeals and Denials Specialist also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding and CDI specialists, responding to client subject matter needs, and providing educational support and training.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Review clinical related denials to determine if appeal should be written
• Write appeals for cases as based on clinical indicators and medical record documentation
• Review process may include reviewing for correct coding as based on Official Coding Guidelines
• Communicates quality issues to management as appropriate
• Assist with identification of, drafting, implementation, and monitoring of quality improvement action plans for coding or CDI consultants
• Provide educational sessions on error trends as requested by management
• Notifying management when there is a compliance concern or incident
• Demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
• Promoting confidentiality and using discretion when handling patient information
• Attend educational conference calls
• Perform other duties as needed with the project
• Maintains required productivity and quality requirements
• Maintains coding/CDI credential requirements

REQUIRED QUALIFICATIONS:

• Candidate must possess an approved CDI and/or AHIMA or AAPC coding credential
• Minimum 5 years’ CDI and/or coding experience recommended; 2 years of auditing experience in an acute care setting required
• Recommend minimum 2 years of Trauma Level 1 and Academic Teaching facility experience
• Must be proficient at ICD-10-PCS coding
• Must pass Intellis/e4 assessment
• EPIC WQ experience required
• Clinical validation experience
• Total quality IP auditing experience required
• Previous denials and appeals experience
• Consultant will review denials to determine if account was coded correctly and if all clinical indicators are met to support the coding; If appeal is needed, use client template to write appeal letter.
• Qualified subject matter experts in clinical documentation improvement, coding conventions

KEY SUCCESS ATTRIBUTES:

• Demonstrates strong collaboration skills
• Has strong analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment
• Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
• Ability to self-motivate and self-direct
• Possess strong time management and organizational skills
• Commitment and adherence to company Core Values

CORE COMPETENCIES:

• Communication
• High level of integrity & ethical judgement
• Consistency and Reliability
• Meeting Standards

BENEFITS:

We offer an excellent salary, full benefits package including 401(k) with company match and discretionary profit sharing, group medical, dental, vision, life, & short-term disability insurance, and PTO policy

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

Sitting, talking, hearing and near vision are required over 90% of the time, while walking is required frequently throughout the day. Standing is required over 10% of the time. Feeling is required 90% of the time and reaching is required about 50% of the time. Bending, twisting and climbing are required, as in far vision, but only for 10% or less of the time. Low levels of lifting (10 pounds of less) is required about 25% of the time, while medium levels (20 to 40 pounds) of lifting and carrying are required less than 5% of the time. Ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations.

Intellis is an equal opportunity E-Verify employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Job Type: Full-time

Pay: From $35.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Inpatient Appeals & Denials: 3 years (Preferred)
• Coding/CDI: 5 years (Preferred)
• Epic: 3 years (Preferred)
• ICD-10: 5 years (Preferred)

License/Certification:

• CDI or AHIMA or AAPC credential (Required)

Work Location: Remote

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