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Physician Coding Denials Specialist (REMOTE)

Company: Fairview Health Services
Location: Saint Paul
Posted on: November 26, 2022

Job Description:


The Physician Coding Denials Specialist performs appropriate efforts to ensure receipt of expected reimbursement for services provided by the Physician. Reviews and analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge and stays abreast of ICD diagnosis codes, CPT physician service codes, coding principles, modifier usage, medical terminology, governmental regulations, protocols and third-party payer requirements pertaining to billing, coding, and documentation.The Physician Coding Denials Specialist will also handle audit-related and compliance responsibilities. Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials. This position requires anticipating and responding to a wide variety of issues/concerns and works independently to plan, schedule and organize activities that directly impact Physician reimbursement. This position will support change management by tracking and communicating trends and root cause to support future prevention with internal customers and stakeholders as well as with payers and third parties. This role is key to securing reimbursement and minimizing avoidable write-off's.


+ Performs critical research and timely and accurate actions including preparing and submitting appropriate appeals or re-billing of claims to resolve coding denials to ensure collection of expected payment and mitigation of denials

+ Maintains extensive caseload of coding denials.

+ Formulates strategy for prioritizing cases and maintains aging within appropriate ranges with minimal direction or intervention from Leadership.

+ Acts as a liaison among all department managers, staff, physicians and administration with respect to coding denials issues.

+ Assists with the development of denial reports and other statistical reports.

+ Reviews insurance coding-related denials, including but not limited to: Diagnosis codes not supported, incorrect or invalid CPT codes, modifier issues, and/or general coding error denials.

+ Responsible for reviewing assigned diagnostic and procedural codes against patient charts using ICD-10-CM, CPT, or any other designated coding classification system in accordance with coding rules and regulations.

+ Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.

+ Contacts insurance carriers as appropriate to resolve claim issues

+ Maintains payer portal access and utilizes said portal to assist in reviewing commercial medical policies

+ Maintains working knowledge of regulatory and third-party policies and requirements to ensure compliance; remains current with applicable insurance carriers' timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to leadership.

+ Assists with short-notice timely filing deadlines for accounts with coding issues.

+ Provides feedback to the coding leadership team regarding coding denials.

+ Compiles training material and educational sessions associated with coding denial-related topics and presents such educational materials. Collaboratively works with the coding education team & coding compliance team to assist in providing education to coders, physicians and mid-level providers.

+ Monitors for coding trends, works collaboratively with the revenue cycle teams to prevent avoidable denials and reduce revenue loss.

+ Identifies, quantifies and communicates risk concerns to leadership and supports mitigation efforts as appropriate. Demonstrates the ability to analyze coded data to identify areas of risk and provide suggestions for documentation improvement.

+ Fulfills all organizational requirements.

+ Completes all required learning relevant to the role.

+ Complies with and maintains knowledge of all relevant laws, regulations, policies, procedures and standards.

+ Fosters a culture of improvement, efficiency and innovative thinking.

+ Recommends process efficiencies, strategies for improvement and/or solutions to align with business strategies.

+ Participate in process improvement meetings and/or discussions, recommending process efficiencies and/or strategies for denial prevention and revenue improvement.

+ Performs all assigned functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Adheres to HIPAA compliance rules and regulations.

+ Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.

+ Educates and mentors new employees through the on-boarding process.

+ Adheres to productivity and quality standards.

+ Performs other duties as assigned.




+ 5+ years of coding-related experience such as coding, abstracting, Data Quality in coding function type as required by position.

+ 1+ years experience in managing and appealing denials

+ 1+ years expertise in reading and interpreting commercial payer medical policies


One of the following:

+ Certified Coding Specialist-Professional (CCS-P)

+ Certified Professional Coder (CPC)



+ Bachelor's Degree in HIM


+ 7+ years of coding related experience such as coding, abstracting, Data Quality in coding function type as required by position.

+ Epic experience in either Resolute Physician Billing


One of the following:

+ Registered Health Information Administrator (RHIA)

+ Registered Health Information Technician (RHIT)

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_Fairview Health Services ( is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 12 hospitals-including an academic medical center and long-term care hospital-serving the greater Twin Cities metro area and north-central Minnesota._

_Its broad continuum also includes 56 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview's 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education._

**_Vaccination Update_**

_As part of our ongoing efforts to protect the wellbeing of our teams and to provide a safe and healthy environment for the patients and communities we serve, all Fairview employees will be required to receive both an annual flu vaccination and the COVID-19 vaccination series. Current employees must have completed both vaccination schedules on or before October 31, 2021.Beginning August 9, 2021, any new hires who are not fully vaccinated against COVID-19 are required to receive their first dose prior to their start date and their second dose (if receiving Moderna or Pfizer vaccines) within 4 weeks of their start date. Annual flu vaccinations are also required before the employment start date for employees who begin employment during the flu season.Accommodations requests will be reviewed on an individual basis._

_EEO/AA Employer/Vet/Disabled All qualified applicants will receive consideration without regard to any lawfully protected status._

**Job Locations** _US-MN-Saint Paul_

**Posted Date** _3 months ago_ _(8/10/2022 10:50 AM)_

**_Requisition ID_** _2022-97931_

**_Profession_** _Business Operations_

**_Speciality_** _Accounting/Finance/Human Resources/Legal_

**_Department_** _Rev Recov - Denials Prevention_

**_Shift_** _day_

**_Hours per 2 weeks_** _80_

**_Location_** _Midway Corporate Campus_

Keywords: Fairview Health Services, St. Paul , Physician Coding Denials Specialist (REMOTE), Healthcare , Saint Paul, Minnesota

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