Supervisor Coding Denials - ECU Health

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

Coding Denials Supervisor will lead a team of coding professionals tasked with identifying, analyzing, and resolving coding related non-clinical denials. This position will work closely with revenue cycle management coding, billing, and denial staff to ensure accurate and timely resolution of coding related non-clinical denials. The supervisor ensures compliance with coding guidelines, regulatory requirements, and payer policies while optimizing revenue cycle efficiency.

This role is responsible for coordinating and monitoring the coding specific denials and non-clinical appeals process in a collaborative environment with revenue cycle management. Working closely with the billing, coding, denial and insurance teams to reduce denial rates and ensure timely reimbursements.

Responsibilities

1. Supervise the workflow for all coding denials staff.

2. Review and analyze coding, bundling, and duplicate denials including identification of root cause.

3. Works with revenue cycle management and staff to ensure claim edit/denial trending data is accurate and that all metrics are reported appropriately including specific ICD-10, current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals.

4. Collaborate with key stakeholders and assist in developing non-clinical appeal strategies to include reference material for staff, letter templates, and regular feedback for revenue cycle coding denial staff; and functions as subject matter expert related to coding denials and non-clinical appeals.

5. Supervise the appeals process, ensuring timely follow-up and resolution of denied claims.

6. Analyze coding denial reason codes, review documentation and respond appropriately regarding what is needed to resolve the denial issue and based on payer guidelines.

7. Supervise and assist in working denials for multispecialty coding, along with E&M coding for all places of services.

8. Continuously evaluate and implement process improvements to enhance efficiency and effectiveness of coding denial management.

9. Train and mentor team members on best practices for denial resolution and appeals.

10. Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials.

11. Analyzes claim edits/denials to identify new trends, opportunities, and educational feedback as needed.

12. Acts as a liaison for issues affecting various teams (coding, revenue integrity, accounts receivable (AR) follow up, etc.) of the revenue cycle while also providing support when IT related or systematic changes are needed.

13. Makes recommendations to revenue cycle leadership on operations and root causes and assists in development of strategies to avoid future coding denials.

14. Provides education to coding denial team and attends monthly billing staff meetings as appropriate.

15. Pursues ongoing professional growth and development to maintain coding certification while remaining current on all coding and regulatory updates in addition to participating in educational activities.

16. Implement process improvements to streamline denial management and enhance efficiency.

17. Work with the revenue cycle management team to achieve and maintain key performance indicators (KPIs)

18. Identify and provide coding denial trends by Payer, CPT code, or any other denial parameters.

19. Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations to prevent future denials.

The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties and responsibilities required of job incumbents. Consequently, job incumbents may be asked to perform other duties as required.

Minimum Requirements

• Minimum of bachelor's degree in a health service-related discipline. Five years of denial recovery experience or revenue cycle related field with a certificate in coding may be substituted.
• Active Coding Certification (RHIA, RHIT, CCS, or CPC)
• Must have experience working in EPIC.

Skill Set Requirement

• Proficient in reimbursement methodologies, hospital information systems and coding methodologies. 
• Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms.
• Ability to analyze complex medical records and identify billable services.
• Strong quantitative, analytical, and organizational skills.
• Understanding of medical records, professional/hospital claims, and the Charge master.
• Ability to utilize and understand computer technology.
• Ability to understand ancillary department functions.
• Possesses a comprehensive knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes.
• Possesses a working knowledge of the UB-04/837 claim form loop and segments.
• Understands charging, coding processes along with compliance issues.
• Has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines.
• Requires knowledge of medical terminology, anatomy and physiology
• Must be team-oriented with strong interpersonal skills.
• Knowledge of the Privacy Act to safeguard patient confidentiality
• Certified Coding Specialist or Certified Procedural Coder

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.