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Denials Management Coding Specialist

Cancer Treatment Centers of America Type Full time Posted 11/20/2013
Salary - n/a - Starts 4/16/2014
IL - Illinois (All) - Zion Referral - n/a -    

Denials Management Coding Specialist

Location:Cancer Treatment Centers of America Operations Center
Region:Zion, IL
Department:428006 PA PARs-Clerical
Employment Status:Full time
Shift Hours / Days:M-F/8:00am - 5:00pm
Hours / Pay Period:80
Position ID:34537
Job Function:Support Services

Description

Denials & Appeals Specialist

We Fight Cancer: Care That Never Quits®

Cancer Treatment Centers of America®(CTCA®) delivers an extraordinary patient experience we callPatient Empowered Care®. We deliver state-of-the-art, high quality care through an integrative model where a team of experts puts patients at the center of their own care. Every day, you will help patients win the fight against cancer. Every day is challenging and rewarding beyond your imagination.

A Culture of Teamwork, Empowerment & Development

CTCA provides Stakeholders with exceptional support and easy access to a wide range of tools and resources they need to bring the best of themselves, every day. Our benefits, wellness, and compensation programs lead the market. Imagine access to your own personal health coach! We also provide extensive training and career development opportunities that encourage professional and personal growth—it is a point of pride. We empower our Stakeholders to deliver the highest standard of care, which we call the Mother Standard®.

TheDenials and Appeals Specialist(DAS) specialize in follow up of denied claims from all commercial and contracted payers. The DAS role will specialist in the investigation of denials that are clinical in nature.  DAS's are responsible to perform timely and appropriate validation and follow up denied claims, including the initial assessment of the denials received via the denials management systems queue (XDM) to determine the appropriate course of action for resolving the claims.  DAS's thoroughly investigate denied claims to ensure timely and proper follow-up for addressing denials including assigning them to the appropriate resources within the denials and appeals management workflow, collaborating with the Clinical Appeals Program Manager to initiate the appeals process, and coordinating with the Insurance Claims Representative (ICR) and/or Accounts Management Specialist (AMS) to complete research to support the claim review and to determine and execute the appropriate course of action for resubmission of the claims to obtain reimbursement.  This role will workr as an integral component of the Denials and Appeal Managment Team providing support to other DAS regarding clinical inquiries.  The DAS is also responsible for supporting the development of business processes for managing the denials and appeals process at CTCA.  They will provide system and process support to the broader multi-functional Denials and Appeals resources.  The DAS will support and administer training for XDM (the denials management technology) and participate in system support activities and may be involved in training other users. The Denials and Appeals Specialists report directly to the Manager of Denials and Appeals.

Education/Experience Level

  • Ability to troubleshoot with strong analytical skills
  • Minimum Licensed Practical Nurse (LPN), either with current license or eligible for license with prior experience as a practicing LPN required
  • Experience writing/assessing clinical appeals
  • Must be a High School graduate or equivalent
  • College Degree Preferred.
  • Must have minimum of 1-2 years experience in healthcare, in a non-clinical/administrative role preferred

Knowledge and Skills

  • Must have strong analytical and troubleshooting skills
  • Ability to read/understand Medical Records and Physician notes
  • Must have excellent organizational skills, be highly productive and able to manage multiple priorities.
  • Must have strong written and verbal communication skills.
  • Must be proficient with a computer and other office equipment with Windows experience
  • Must have experience with current ICD coding methodology, insurance terminology and ability to read an Explanation of Benefits.
  • Must be willing to travel as needed

The Best Place to Work

We call ourselves Stakeholders because we all have a stake in the care and success of every patient. Today, CTCA Stakeholders deliver healing and hope to patients fighting complex and advanced cancer in Atlanta, GA, Chicago, IL, Philadelphia, PA, Phoenix, AZ and Tulsa, OK. Each of our hospitals, and corporate entities, earned aBest Place to Workdistinction and receives numerous accreditations that celebrate our culture of clinical quality, innovation, high performance and wellness.

Beyond The Resume, What We Look For

We select people with talent—people who value working with others and thrive in an environment of continuous improvement. We are creative and resourceful problem solvers. We are inventors and innovators. As a CTCA Stakeholder, you makethedifference in the life of a patient.

Do you see yourself working with a passionate team in a dynamic, high growth environment? Visitwww.cancercenter.com/careersto begin your journey.

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