Denial Recovery Coding Analyst

Overview

Work remotely while using denial management expertise to support healthcare operations and improve reimbursement across the enterprise.

The role focuses on denial analysis, coding validation, appeals, and process improvement to reduce denial rates and strengthen revenue cycle performance.

Responsibilities

• Manage clinical denials from work queues, including claim resubmission, authorization verification, payer reprocessing, reconsiderations, and appeals.
• Work with Managed Care and payer partners to reduce denials and increase reimbursement.
• Analyze denial trends and recommend coding and documentation process improvements.
• Maintain productivity and accuracy standards while working assigned denial queues.
• Use ICD-10, CPT, HCPCS, NCCI, and CMS guidelines to review, code, and correct accounts.
• Track and resolve denials, investigate compliance issues, and report root causes and trends.
• Research payer denials related to authorization, medical necessity, non-covered services, coding, and billing.
• Submit detailed reconsiderations and appeals based on medical record review and payer policies.
• Review payer communications for reimbursement risks and prior authorization requirements.
• Apply coding corrections, modifier changes, and diagnosis sequencing adjustments as needed.
• Partner with departments to educate staff, improve processes, and reduce charging and authorization-related denials.
• Analyze denied claims to identify root causes and reimbursement issues.