Medical Coding Dispute Specialist

Description

The Medical Coding Dispute Specialist is responsible for reviewing provider disputes and appeals for all lines of business at Network Health. This role requires advanced claims knowledge, medical coding experience, knowledge about provider reimbursement and a solid understanding of business operations.

Location : Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha will be required occasionally for the position, including on first day.

Hours : 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities :

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Develops detailed summaries and written responses for appeals, ensuring all findings are captured and trend information is included when requested.
• Produces clear, regulation-compliant communications for appeals, disputes, and grievances, presenting information accurately and succinctly.
• Analyzes claims workflows, contractual terms, reimbursement schedules, and system setups to pinpoint the underlying causes of payment discrepancies.
• Maintains current knowledge of payor reimbursement policies.
• Identifies coding and documentation issues and brings to the attention of the department manager
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD / NCD) directives
• Maintain an understanding and apply knowledge of Medically Unlikely Edits (MUEs), and applicable regulatory requirements as well as payer guidelines to select appropriate codes and modifiers.
• Be able to review health care claims of intermediate to high complexity.
• Be able to identify overpayments or underpayments on claims.
• Ensures that desk level procedure (DLP) documents are kept current.
• Research and respond to coding questions from internal and external clients.
• Actively participates in shared accountability and commitment for departmental and organization-wide results.
• Prioritize workload to ensure deadlines are met weekly.
• Help with training associates as needed.
• Other duties as assigned.

Job Requirements :

Network Health is an Equal Opportunity Employer

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.