Denial Recovery Coding Analyst

Overview

Work remotely while using your denial management expertise to make a direct impact on healthcare operations.

• Work style: Remote
• Location requirement: Must reside in an approved state: FL, GA, PA, NC, SC, TN, or TX
• FTE: Full-time (1.0 FTE)

Responsible for maintaining low denial rates and optimizing reimbursement across the enterprise by ensuring high coding standards and effective denial management practices. Leads and supports initiatives to improve coding accuracy, reimbursement outcomes, and appeal turnaround times.

Performs in-depth analysis of denial trends, including Epic system edits, coding validation, Charge Description Master (CDM) processes, authorization trends, and payer denials. Identifies opportunities for performance improvement and implements strategies to enhance revenue cycle outcomes.

Educates departments on appropriate charging, billing, and coding practices to ensure regulatory compliance. Collaborates with Managed Care, Compliance, and operational teams to resolve complex issues with departments and payers, driving sustainable improvements in reimbursement and denial prevention.

Responsibilities

• Manage clinical denials from assigned denial workqueues, including claim resubmissions, authorization verification, payer claim reprocessing, reconsiderations, and appeals.
• Partner with managed care teams and payers to reduce denials and maximize reimbursement.
• Identify opportunities to improve coding and clinical documentation based on denial trends and coding guidelines.
• Meet established productivity and quality standards while managing assigned denial workqueues.
• Review and correct accounts using coding software, NCCI, ICD-10, CPT, HCPCS, and CMS coding guidelines.
• Collaborate with department leadership to investigate, track, trend, and resolve coding, charging, billing, and compliance issues.
• Manage multiple payer workqueues, including Medicare, Medicaid, Medicare Advantage, commercial, and government payers.
• Research denials related to authorization, medical necessity, coding, billing, non-covered services, and documentation, initiating timely appeals to prevent filing deadline issues.
• Prepare detailed reconsiderations and appeal submissions based on medical record review and organizational policies.
• Identify payer-specific denial trends, perform root cause analysis, and escalate findings to management for corrective action.
• Review payer communications to identify reimbursement risks related to medical policies and prior authorization requirements.
• Review and correct coding, modifiers, diagnosis sequencing, and charges in accordance with coding, charging, documentation, and billing guidelines.
• Partner with operational departments to educate staff, improve documentation and authorization practices, reduce denials, and strengthen overall revenue cycle performance.