Acute Coding Appeals SpecialistEnsemble Health Partners • New York, New York, United States
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Acute Coding Appeals Specialist
Ensemble Health Partners
- New York, New York, United States
- New York, New York, United States
Über
O.N.E. Purpose
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our Best in KLAS Ensemble Difference Principles and consistently delivering outstanding results.
The Opportunity CAREER OPPORTUNITY OFFERING:
Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
This position pays between $29.70 - $31.80 based on experience
Position Summary The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. This role draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise to substantiate coding principles and identify potential billing/coding issues and quality concerns. Under indirect supervision, the Coding Appeals Specialist reviews and writes appeals for inpatient Diagnosis Related Group (DRG) denials to support the assigned DRG and address the clinical documentation used 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, drawing on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise to substantiate coding principles and identify issues and quality concerns.
Participates in client system education to gain knowledge necessary to appeal client accounts, ensuring coding is supported by the patient’s clinical documentation, coding/cdi guidelines, and regulatory standards.
Maintain meticulous documentation, spreadsheets, accounts, and claim examples of root cause issues. Perform searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules to identify coding and billing requirements and make recommendations to the client.
Assist in education and training for client coding staff as it relates to the outcomes of the coding appeals.
Meet established productivity standards for coding appeals and coding certification requirements.
Attend in-house sessions to receive updated coding information and changes in coding/regulations.
Provide excellent customer service in an organized and efficient manner with a positive attitude.
Required Experience
Previous inpatient facility coding experience, working appeals, denials and edits
5 years of coding experience required
Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
Must be inquisitive and open to innovation including AI to improve processes and 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 needed
Minimum Education
High School Diploma or GED
Required Certification
Active Coding Certification (e.g., 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); HFMA MAP Awards for High Performance in Revenue Cycle (2019-2024); Everest Group RCM Operations PEAK Matrix; HBI Revenue Cycle Awards; Energage Top Workplaces USA; Fortune 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, Ensemble empowers people with tools and resources to thrive, including:
Associate Benefits – comprehensive benefits package supporting health, time off, retirement, and well-being
Culture – collaborative, growth-oriented environment that places people first
Growth – professional development and tuition reimbursement opportunities
Recognition – incentive programs for employees who excel
Ensemble is an equal employment opportunity employer. It is our policy not to discriminate 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 law. Ensemble prohibits harassment of applicants or employees based on these categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the ADA and applicable state/local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
This posting addresses state-specific requirements to provide pay transparency. Compensation decisions consider factors such as location, knowledge, skills, experience, education, licensure, internal equity, and time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.
Employment Disclaimers – Ensemble
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Sprachkenntnisse
- English
Hinweis für Nutzer
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