Deskripsi Pekerjaan
Are you an expert in medical coding and healthcare compliance? Sales Rain BPO Inc. is seeking a detail-oriented Outpatient Coding Appeals Specialist to join our growing team. In this pivotal role, you will serve as the guardian of revenue integrity, reviewing complex medical records and payer policies to support effective appeal arguments. You will ensure that healthcare providers are reimbursed fairly and that coding standards are upheld to the highest level of accuracy.
As an Outpatient Coding Appeals Specialist, you will be at the forefront of the healthcare revenue cycle, bridging the gap between clinical documentation and payer adjudication. We offer a dynamic BPO environment where your expertise will directly impact patient access to care and organizational financial health. If you possess a strong background in medical coding and a passion for problem-solving, we want to hear from you.
Tanggung Jawab
- Comprehensively review outpatient medical records to ensure accurate diagnosis and procedure coding (ICD-10, CPT).
- Analyze payer policies and medical coding guidelines to identify the root cause of denied claims and prepare strong appeal arguments.
- Draft and submit detailed medical coding appeals and documentation requests to insurance payers and government agencies.
- Collaborate with healthcare providers and clinicians to clarify medical records and obtain necessary supporting documentation.
- Monitor appeal status and track reimbursement outcomes to measure the effectiveness of coding strategies.
- Stay updated on regulatory changes, CMS guidelines, and evolving healthcare reimbursement models.
Kualifikasi
- Associate’s degree or certification in Medical Coding (e.g., CCS, CPC, RHIT, RHIA) is highly preferred.
- Minimum of 2-3 years of proven experience in outpatient coding, medical records review, or medical billing.
- Strong working knowledge of CMS guidelines, Medicare/Medicaid policies, and private payer appeal processes.
- Proficiency in medical coding software and Electronic Medical Records (EMR) systems.
- Excellent analytical skills with a keen eye for detail to detect coding discrepancies.
- Strong verbal and written communication skills to effectively negotiate with payers and providers.
- Ability to work effectively in a fast-paced BPO environment while maintaining high productivity standards.