Clinical Denials Specialist
Pasig City, National Capital Region
Posted today
- Company:
- Coronis Health
- Company Description:
- Coronis Health, a leading revenue cycle management provider, helps healthcare organizations thrive through a data-driven, customized approach to optimizing RCM. By combining transparency, advanced automation and AI, our solutions seamlessly integrate with existing systems to boost efficiency without the need for new platforms. Backed by industry veterans, we offer expert guidance to navigate complex regulations and streamline processes. We are committed to delivering innovative, tailored RCM solutions that help healthcare providers maximize revenue, improve performance and focus on what matters most—patient care.
- Contract Type:
- Full Time
- Experience Required:
- 1 year
- Education Level:
- Bachelor’s Degree
- Number of vacancies:
- 2
Job Description
Key Responsibilities
1. Prepare and process accounts timely and accurately based on client requirement.
2. Review daily account/edit reports from work queues and/or in external billing software and makes necessary corrections or resolve edits to allow electronic submission.
a. Resolving edits prior billing (Compliance)
b. Resolving rejections from the payor (Rejection)
3. Reviews and make appropriate actions such as but not limited to:
a. Medical Necessity edits,
b. Local Coverage Determination (LCD) and National Coverage Determination (NCD) edits
c. National Correct Coding Initiative (NCCI) edits
d. Modifier edits
e. Payer specific edits
f. Medically Unlikely Edits (MUE)
g. Procedure to Procedure (PTP) edits
h. Diagnosis issue
4. Enter appropriate account notes into the billing system to clarify actions taken to reconcile claims.
5. Maintains confidentiality of patient records at all times Observes HIPAA compliance.
6. Perform as a team player.
7. Use logic, critical thinking and reasoning to identify the strengths and weaknesses of alternative solutions to problems.
8. Understand the effects of new information for both current and future problem-solving and decision-making.
9. High attention to detail
10. Attendance in accordance with company HR and department policies
11. Other tasks/functions that may be assigned by the company as per business requirement; these may change from time to time to reflect the changing requirement of your position and our business
Qualifications:
-Bachelor of Science in Nursing or Medical Allied Health Course.
-Preferred experience in revenue cycle (medical coding), knowledge of ICD-10, CPT procedures, and clinical or hospital settings.
-Certification required: AAPC (CPC, COC, CIC) or AHIMA (CCA, CCS-P, CCS).
-Willingness to work on temporary work from home set-up.
