Surgical coding specialist. Revenue procurement.

Pre certifications, appeal writer, manager of time, revenue recovery, coding audits, works hand in hand with provider post surgical procedure

As a denials and appeals Specialist (DAS) specialize in follow up of denied claims from all commercial and contracted payers. DAS's are responsible to perform timely and appropriate validation and follow up denied claims, including the initial assessment of the denials received via the denials management systems queue (XDM) to determine the appropriate course of action for resolving the claims. DAS's thoroughly investigate denied claims to ensure timely and proper follow-up for addressing denials including assigning them to the appropriate resources within the denials and appeals management workflow, collaborating with the Clinical Appeals Program Manager to initiate the appeals process, and coordinating with the Insurance Claims Representative (ICR) and/or Accounts Management Specialist (AMS) to complete research to support the claim review and to determine and execute the appropriate course of action for resubmission of the claims to obtain reimbursement. The DAS is also responsible for supporting the development of business processes for managing the denials and appeals process at CTCA. They will provide system and process support to the broader multi-functional Denials and Appeals resources. The DAS will support and administer training for XDM (the denials management technology) and participate in system support activities. The Denials and Appeals Specialists report directly to the Manager of Denials and Appeals.

Radiology coding and ICD-10 training. Working with medical record and reports to code to the best standards for ICD-9 coding guidelines. Worked with Code correct and MEd FM software.