Clinical Denials Triage Specialist

We're Hiring: Clinical Denials Triage Specialist!

We are seeking a detail-oriented and analytical Clinical Denials Triage Specialist. The ideal candidate will play a crucial role in reviewing, analyzing, and resolving clinical denial cases to ensure efficient revenue cycle management.

Location: Philippines
Work Mode: Hybrid
Role: Clinical Denials Triage Specialist

What You'll Do:
Claim follow up, closure, appeals & denials
Ability to understand and read explanation of benefits
Experience in reviewing denied claims and following the appropriate steps to resolution.
Experiencing with appealing denied claims, usage of payer portals, and determining root cause.
Validates codes, charges and other edits flagged in Athena or EPIC for review.
Review documentation to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units)
Uses CCI edit software to check bundling issues, modifier appropriateness, and LCDs/NCDs for medical necessity.
Review claims for diagnoses, treatments, and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.
Meet and/or exceeds the established coding productivity standards
Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines

Qualifications:
Clinical Knowledge / Medical Allied
Must have an active coding certification (CPC, COC or CCS)
Denials Management or Denials Intake process for about 2 years
Coding experience for less than a year is subject for HM screening & approval