Job Description
Essential Functions: Audits charts and revies clinical records ensuring all diagnostic and procedural codes and modifiers strictly adhere Identifies trends in improper coding or other communication shortcomings that may lead to claim denials or audits Complies with all medical coding guidelines and monitors evolving regulatory and industry changes Provides targeted education, direct coaching, and facilitates training programs tailored to each medica specialty upon translating audit findings Fol…
7:30 AM
Log in and pull the overnight denial queue. Your worklist shows 40–80 claims flagged by the payer in the last 24 hours. Sort by do…
8:00 AM
Start working the queue. For each denial, you're reading the remittance advice, identifying the denial reason code (CO-4, CO-50, C…
9:30 AM
Hit a complex medical necessity denial from a Medicare Advantage plan. Open the patient chart, pull the clinical documentation, an…
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