Coding Denial Specialist

Full-time, 40 hours/week

Monday-Friday 8am-4:30pm

Remote

Summary:

The Denial Coding Specialist supports the Revenue Recovery team by reviewing claims for coding accuracy and root causes for coding-related denials, as well as proposing process improvements to mitigate future denials. Working closely alongside the Physician Advisor, the Denial Coding Specialist liaises between the Revenue Recovery team and providers, resolving queries for missing documentation and promoting departmental awareness of coding best practices. This position reports to the Revenue Recovery Supervisor.

Responsibilities:

1. Performs retrospective account reviews and resolves coding denials accordingly.
2. Analyzes coding-related denials (e.g., bundling issues and inappropriate CPT/diagnoses) to identify trends and root causes
3. Proactively maintains current knowledge of applicable regulations, requirements, changes, and best practices by following industry sources (e.g., Centers for Medicare & Medicaid Services, American Association of Professional Coders, and professional journals)
4. Reviews EPIC work queues daily for Denial management and makes necessary and appropriate coding changes based on medical documentation for both professional and technical charge revenue.
5. Follows up with providers to resolve outstanding queries for additional documentation or diagnosis information
6. Coordinates and/or completes appeals as applicable with payors.
7. Develops suggestions for coding and documentation process improvements, based on denial analysis and industry coding guidelines
8. Extracts data into clear reports to revenue recover and revenue cycle leadership, physician advisor, and providers
9. Partners with Revenue Cycle team leaders, physicians, and providers to develop and implement process improvements
10. Provides regular feedback and ad-hoc education to revenue recovery staff and providers to promote departmental knowledge of appropriate coding practices
11. Other duties as required.

Other information:

Technical Expertise

1. Experience in CPT and ICD coding is required.
2. Experience working with all levels within an organization is required.
3. Experience working in an Electronic Medical Record system preferred
4. Experience in healthcare is preferred.
5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required.

Education and Experience

• Education: High School Diploma or equivalent is required; Bachelor's degree is preferred.
• Certification: AAPC or AHIMA Coding Certification is required.
• Years of relevant experience: 0 to 2 years is preferred.
• Years of experience supervising: None.

Credentials

Essential (minimum one as applicable):

• American Academy of Professional Coders
• American Health Information Management Association
• Certified Provider Credentialing Specialist
• Certified Coding Specialist
• Registered Health Information Technician
• Certified Coding Associate

Full Time

FTE: 1.000000

Status: Remote