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Medicare Denials & Appeals Specialist (Certified Coder)

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Job Details
Job Order Number
Company Name
Kent General Hospital
Physical Address

Dover, DE 19904
Job Description

Medicare Denials & Appeals Specialist (Certified Coder)

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Patient Financial Services


Full time 80 (Two week Payperiod)




Pay Grade 050 (Minimum hourly rate $22.09/hr)



Job Details

The Specialist is responsible for appealing denied Governmental payer claims. The Specialist must effectively interact with multiple disciplines including Patient Access, Hospital Information Management, Charge Description Master, Contract Management, physicians, commercial insurance and government agencies. The Specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services. This position requires a Coding Certification as the Specialist will be reviewing medical necessity denials and adding modifiers or writing appeals as appropriate to support the denied service.

Minimum Education and Experience:




Associate’s Degree or four years of patient accounting experience with a HS Diploma or GED.

Bachelor’s degree in Business or Finance


At least six months to one year of coding or patient accounting experience.

Five years hospital billing or collections experience. Prior written clinical appeal experience.

Computer/Software Knowledge:

Experience with medical billing and/or claims editing systems. Intermediate experience in Microsoft Word and Excel.

Experience with Epic

Advanced experience in Microsoft Word and Excel.


Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS)

Certified Revenue Cycle Specialist (CRCS)

Special Knowledge, Skills, and/or Abilities:

+ Knowledge of revenue-cycle, managed care environment, 3rd party reimbursement, and hospital financial resources.

+ Position requires comprehensive knowledge of applicable Federal, State and commercial insurance regulations, insurance plans, member eligibility and medical billing and collections.

+ Knowledge and understanding of CPT/HCPCS and ICD-10 codes, UB04 and CMS 1500 claim forms and the difference between technical and professional fee charges.

+ Exceptional written, verbal and interpersonal communication skills; must demonstrate ability to articulate information in a clear and informative manner.

+ Ability to read and interpret documents such as an Explanation of Benefits and/or Remittance Advice and properly identify denials and patient responsibility amounts from remittances required

+ Detail oriented, strong problem solving and analytical skills.

+ Ability to multitask and use multiple windows/programs at one time.

+ Knowledge of payer specific contractual billing obligations.

+ Knowledge of State insurance regulations related to medical claims payment.

+ Must be proficient in reading, writing, and speaking English

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