Denial Recovery Coding Analyst | Enterprise Denial Management | Remote (must reside in FL, GA, PA, NC, SC, TN or TX)

Responsible for maintaining a low denial rate and high reimbursement rate at an

enterprise level. To maintain a high coding standard within the enterprise. Organizes and plans projects to improve effectiveness of dynamic coding, reimbursement rates, and appeal turnover rates. Performs analysis for denial trend improvement to include EPIC system edits, coding validation, CDM processes that affect reimbursement, authorization trends and performance improvement, and payer denial trends. Educates departments on appropriate charging/billing/coding issues to ensure regulatory compliance. Works with managed care and compliance to resolve issues with departments and payers.

Key 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
• Meets established 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
• Research 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
• Educates departments on denial prevention strategies, including improvements in coding, charging, and authorization processes

Minimum Qualifications:

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