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Acute Coding Appeals Specialist

Ensemble Health Partners -
Remote

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Job Details

Full-time
$29.70 - $31.80 an hour

Benefits

Health savings account
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
Professional development assistance
Life insurance
Retirement plan

Qualifications

Appeals
Inpatient experience
Medical coding
High school diploma or GED
Certified Professional Coder
Medical insurance appeals management
Insurance claims appeal handling
Hospital experience

Full Job Description

CAREER OPPORTUNITY OFFERING:

Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
This position pays between $29.70 - $31.80 based on experience

The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG 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 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/denials activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG 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 education and training for client coding companion as it relates to the outcomes of the coding appeals
Meet established productivity standards for coding appeals & coding certification requirement
Attends 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

Required Experience:

Previous inpatient facility coding experience, working appeals, denials and edits
5 years previous experience in coding, required
Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Minimum Education:

High School Diploma or GED

Required Certification:

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

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

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

Ensemble 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 [email protected].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Pay: $29.70 - $31.80 per hour

Benefits:

401(k)
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Parental leave
Professional development assistance
Retirement plan
Tuition reimbursement
Vision insurance

Application Question(s):

Do you have inpatient facility coding experience working appeals, denials, and edits?

Experience:

Medical coding: 5 years (Required)

License/Certification:

RHIA, RHIT, CCS, CIC, CPC, and/or COC (Required)

Work Location: Remote

Quick Apply

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