the smart solution for Alpharetta jobs

Denials Coder Prevention Associate

Company: CIOX Health
Location: Alpharetta
Posted on: June 13, 2018

Job Description:


Job purpose:

The purpose of the Denial Coder Prevention Associate is to ensure quality of patient care, effective utilization of available health services, review of admissions for medical necessity and necessity of continued stay in the inpatient patient setting or discharge to an alternative level of care.

Duties and responsibilities

* Responsible for providing timely referral/appeal determination by accurate

* Usage of the Milliman Care Guidelines and or Interqual

* Appropriate letter language to author appeal letter

* Identification of referrals to the medical director for review

* Appropriate selection of preferred and contracted providers

* Proper identification of eligibility and healthcare plans

* Maintaining compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards

* Works directly with the provider(s) and health plan Medical Director as needed to facilitate timely authorizations and/or denial reversals

* Maintains and keeps in total confidence, all files, documents and records

* Meets or exceeds production and quality metrics

* Attend all mandatory meetings and trainings

* Review, interpret and verify evaluation and management (E&M) and procedural codes according to the physician's documented office visit notes, orders, hospital notes and other pertinent physician documentation loaded in the medical record.

* Utilize coding expertise to accurately code diagnoses based on the physician's documented diagnosis.

* Identify and code global services and/or appropriate concurrent services according to coding guidelines, and applies correct modifiers.

* Where necessary, correct codes that have been assigned by physician practices to ensure data and codes are consistent with ICD-10 CM Official Guidelines, CPT, and CMS.

* All other job related duties as it relates to job function as delegated by management



* To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. List below is representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to preform the essential functions

* Knowledge of CMS, State Regulations, URAC and NCQA preferred

* ICD10 and CPT coding a plus

* Experienced computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus.

* Minimum Experience: 3 to 5 years

* Requires one of the following coding certifications: Certified Professional Coder (CPC),Certified Coding Specialist Physician (CCSP), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Associate (CCA) through American Health Information Management Certification

EEO Employer F/M/Vet/Disabled

Keywords: CIOX Health, Alpharetta, Denials Coder Prevention Associate, Other, Alpharetta, Georgia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Other Jobs

Virtual Call Center Needs Workers
Description: TeleReach Corporate is a national telephone-marketing firm engaged exclusively in outbound business to business calls. We offer a unique opportunity with an excellent earning
Company: TeleReach Corporate
Location: Alpharetta
Posted on: 06/18/2018

Helicopter Manufacturing Design Specialist
Description: Helicopter Manufacturing Design Specialist Position with Atlanta-based manufacturing design speciality firm in Avation, with expertise particularly in Helicopter Design. Position will be responsible for (more...)
Company: Confidential
Location: Atlanta
Posted on: 06/18/2018

Seasonal Partner Services Represenative (Remote)
Description: Our team is passionate about helping people go skiing and snowboarding more often The Role: We established high-performance Partner Services Team enhances our partners' experience with world-class enterprise (more...)
Company: Mommy Jobs Online
Location: Atlanta
Posted on: 06/18/2018

Policy TitleTypists
Description: We area national specialty staffing company providing highly qualified employees to niche industries. Our focus is quality and our industry-savvy Account Managers recruit the most competent and skilled (more...)
Company: Mommy Jobs Online
Location: Marietta
Posted on: 06/18/2018

Training Specialist Flexible PT Hours
Description: Currently interviewing - Work 100 Online PT/FT positions as Training Specialist and Healthcare Benefits Specialist. Must have excellent
Company: TQS
Location: Roswell
Posted on: 06/18/2018

Mortgage Loan Officer
Description: Job DescriptionAmeriSave Mortgage is expanding our Atlanta office We are a well-known, industry respected mortgage lender with top lender rankings on Lending Tree, Consumer Affairs, Bankrate, Zillow (more...)
Company: AmeriSave Mortgage
Location: Atlanta
Posted on: 06/18/2018

Now interviewing - Work from home
Description: Premiere Health Benefits Company is looking to grow our awesome team. You do
Company: Health Benefits Company
Location: Atlanta
Posted on: 06/18/2018

Company: Confidential
Location: Atlanta
Posted on: 06/18/2018

Job Fair - Cumberland Mall
Description: br br Job Title br br br Job Fair - Cumberland Mall 742 br br br br br Location br br br 0742 - XXI - Cumberland Mall - ATLANTA, GA 30339 US Primary
Company: Forever 21
Location: Atlanta
Posted on: 06/18/2018

CDL-A OTR Truck Driver (Dry Van) - Up to $.47/mi + Bonuses Available!
Description: Get home weekly or bi-weekly with CDL-A truck driver opportunities at Sharp Transport. We're hiring dry van drivers to haul no-touch freight
Company: Sharp Transport
Location: Alpharetta
Posted on: 06/18/2018

Log In or Create An Account


Forgot password?

Find us on Facebook

Find us on LinkedIn

Get the latest Georgia jobs by following @recnetGA on Twitter!

Alpharetta RSS job feeds