Denial Recovery Coding Analyst | Enterprise Denials

Responsibilities

• Manages clinical denials from assigned work queues, including claim resubmissions, authorization verification, payer reprocessing, reconsiderations, and appeals
• Partners closely with Managed Care and payers to reduce denials and improve reimbursement outcomes
• Analyzes denial trends and develops recommendations to improve coding accuracy and documentation practices
• Maintains productivity and accuracy standards, including reviewing approximately 30 accounts per day with a 98% accuracy rate
• Applies coding guidelines (NCCI, ICD-10, CPT, HCPCS, CMS) to accurately review, code, and correct accounts
• Collaborates with department managers to track, report, and resolve denials, including participating in audits and compliance reviews
• Identifies root causes of denials, tracks trends, and escalates findings to leadership for follow-up and process improvement
• Works across multiple payer work queues, including Medicare, Medicaid, government, and commercial payers
• Researches denials related to authorization, medical necessity, non-covered services, coding, and billing issues, ensuring timely resolution and appeal submission
• Prepares and submits detailed, well-supported reconsiderations and appeals based on medical record review and payer requirements
• Monitors payer communications and policy updates to identify risks impacting reimbursement and authorization requirements
• Reviews and corrects coding, including modifier usage, diagnosis sequencing, and compliance with coding guidelines
• Reviews and adjusts charges as needed based on documentation, billing, and regulatory standards
• Edits and corrects claims, including modifiers, diagnosis sequencing, and compliance with coding guidelines
• Provides training and education on denial prevention strategies, including improvements in coding, charging, and authorization processes

Qualifications

• A High School Diploma or GED is required
• One of the following coding certifications is required: CPC, COC, RHIT, RHIA, or CCS
• At least 1–2 years of coding experience, along with 1–2 years of denial management and/or insurance-related experience