ADEC Kenya Services EPZ Limited (ADEC Kenya), ADEC Innovations’ outsourcing headquarters in Africa, hosts the company’s business process outsourcing (BPO) and knowledge process outsourcing (KPO) services, to providing data-entry services, research data trace, data and document management and back office support. ADEC Kenya also offers eLearning services through ADEC Innovations’ capabilities in curriculum design and content development; certifications, simulations and assessments; learning management systems; mobile learning systems; and content conversion. Launched in 2014, ADEC Kenya is an expert in bringing cost-effective onshore and offshore BPO solutions globally.

ROLE SUMMARY

Join our dynamic team as an OP Coding Denial Associate, where you will play a crucial role in overseeing the review of members and ensuring accurate billing as per the company’s protocols with an accounting background you will be responsible for coding and documenting adjustments to medical claims, specifically to address and justify denial issues. The position involves reviewing denial reasons, applying appropriate adjustment codes, and ensuring all documentation supports the accuracy of these adjustments while maintaining high standards of quality and efficiency in all work.

KEY RESPONSIBILITIES:

• Monitor and follow up on unpaid or denied insurance claims, focusing on coding adjustments to support denial resolutions and ensure timely reimbursement
• Monitor and follow up on unpaid or denied insurance claims to ensure timely reimbursement.
• Identify reasons for claim denials, prepare and submit technical appeals, and work towards resolving issues.
• Maintain accurate records of all coding adjustments and actions taken on claims. Provide regular updates and reports on the status of accounts and adjustments.
• Interact with insurance companies, healthcare providers, and internal teams to address coding and billing issues, ensuring accurate justification for denials and adjustments.
• Maintain accurate records of all communications and actions taken on accounts.
• Collaborate with other departments, such as billing, coding, and patient services, to address and resolve payment-related issues.

 QUALIFICATIONS & REQUIREMENTS

• Completed a 4-year Nursing or Medical-allied course.
• 1-2 years of experience in coding denials management or appeal writing related to coding disputes.
• Understanding of medical terminology and Medical Insurance.
• Knowledge of CPT, HCPCS, and ICD-10 codes.
• The ability to communicate articulately and concisely about the things they are working on.
• Collaboration with other teams within the company to facilitate accurate and timely billing.
• Experience using spreadsheets and accounting software.
• US Healthcare industry experience will be an added advantage.
• Flexible to accommodate night shift and must be staying within or ready to relocate to Kitengela, Athi River, or Mlolongo.