Job Description
Job Location: Washington Regional Med. Ctr. - Fayetteville, AR 72703
Position Type: Full TimeEducation
Level: High School Diploma or GED
Job Category: Business Services/Revenue Cycle ManagementOrganization Overview, Mission, Vision and Values
Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for five consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 40 clinic locations, the region’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.
Position Summary
The role of the Appeals Coordinator reports to the Revenue Integrity Manager. This position is responsible for the management and resolution of claim denials. partnering with the coding department, business office and charge departments to resolve edits on failed claims and claim scrub reports. This position must ensure accurate CPT, UB codes and modifiers are appropriately reported on claims and is responsible for auditing charts for services provided to both inpatients and outpatients. The incumbent will perform focus bill audits when needed and will work with system staff on issues related to documentation in the medical records.
Essential Position Responsibilities
- Resolve edits, claim scrub issues and hold bills
- Ensure CPT, UB codes and modifiers are accurately reported on claims
- Provide education to correct inappropriate use of CPT codes and modifierd
- Partner with staff to correct issues related to documentation in medical records
- Perform focus bill audits as needed
- Prepare compliance related audits and provide information for reports, as requested
- Cross train to assist with other departmental duties, as requested
Qualifications
- Education: Bachelors in Health Information Services, preferred.
- Licensure and Certifications: RHIA, RHIT, CCA, CCS, CPC, COC, OR CPMA , required
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Experience: Minimum coding experience of 2-3 years or 3-5 years auditing clinical records, medical necessity, coverage policies and CMS and commercial insurance rules and regulations, required.
Work Environment: This position will spend 80% of work time sitting while performing work in a standard office environment and 20% of work time standing and/or walking short distances while occasionally pushing, pulling, lifting and/or carrying up to 50 lbs.
