Denial Recovery Coding Analyst | Revenue Integrity

Responsibilities

• Manages clinical denials from clinical denial workqueues including claim resubmission, authorization verification, payer claim reprocessing, claim reconsiderations, and appeals.
• Works closely with managed care teams and payers to reduce denials and increase reimbursement.
• Develops recommendations for coding and documentation process improvements based on denial analysis and coding guidelines.
• Completes assigned work within established productivity and accuracy standards, including processing assigned denial workqueues while maintaining quality expectations.
• Uses coding software, NCCI, ICD-10, CPT, HCPCS, and CMS coding guidelines to accurately review, code, and correct accounts.
• Collaborates with department managers to report, track, and resolve denials.
• Aids in investigations and audits to identify, correct, trend, and report charging, coding, and billing compliance issues.
• Manages assigned payer workqueues including Medicare, Medicaid, government payers, commercial payers, Medicare Advantage plans, and other payer types.
• Researches payer denials related to authorization, medical necessity, non-covered services, coding, and billing, and initiates timely reconsiderations and appeals to prevent filing denials.
• Prepares detailed, customized reconsiderations and appeals based on medical record review and organizational policies and procedures.
• Identifies denial trends and escalates root cause findings to management for additional follow-up and process improvement.
• Reviews payer communications to identify reimbursement risks related to medical policies, coverage requirements, and prior authorizations.
• Reviews and corrects coding, modifiers, diagnosis sequencing, and charges in accordance with coding, charging, and billing guidelines.
• Partners with departments to educate staff and improve documentation, coding, charging, and authorization processes to reduce denials and improve reimbursement.

Qualifications

• A High School Diploma or GED is required.
• One of the following coding certifications is required: CPC, COC, RHIT, RHIA, or CCS.
• One to two years of coding experience, along with one to two years of denial management and/or insurance-related experience are required.