Acute 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 Acute 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.

Job Responsibilities :

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 concerns

Participates 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 appropriate

Maintain 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 client

Assist 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 appeals

Meet established productivity standards for coding appeals & coding certification requirement

Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and / or regulations

Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude

Experience We Love :

Previous outpatient facility coding experience, working appeals, denials and edits

5 years previous experience in coding, required

Active Coding Certification RHIA, RHIT, CCS, CIC, CPC, COC, etc.)

Advanced knowledge of medical coding and billing systems, documentation,and regulatory requirements

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Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

Innovation

Work-Life Flexibility

Leadership

Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include :

• Associate Benefits We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always.

Our culture is rooted in collaboration, growth, and innovation.

• Growth We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws.

Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

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 .

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