Denial Recovery Coding Analyst | Enterpirse Denials
工作方式：远程 位置要求：必须居住在批准的州 （FL, GA, PA, NC, SC, TN 或 TX）FTE:全职 (1.0 FTE) 负责通过确保高编码标准和有效的拒绝管理实践来维持低拒绝率并优化整个企业的退款。领导并支持提高编码准确性，退款结果和上诉转换时间的倡议。执行了拒绝趋势的深入分析，包括 Epic 系统编辑，编码验证，收费描述总理 (CDM) 流程，授权趋势和付款人拒绝。确定绩效改善的机会并实施增强收入周期结果的战略。教育部门有关适当的收费，发票和编码实践以确保监管合规。与管理护理，遵守和运营团队合作解决与部门和付款者之间的复杂问题，推动退还和拒绝预防可持续改进。责任关键责任 · 管理临床拒绝工作队列的临床拒絕，包括重新提交索赔，授权验证，付款人索赔再处理，要求重新考虑和上诉。· 与管理护理团队和付款人密切合作以减少拒绝并增加退还。·基于拒绝分析和编码指南制定编码和文档流程改进建议。· 完成生产力和准确性标准内的所有任务，包括满足8小时计划的工作期间经营30个账户的分配生产力目标，从分配的拒绝工作排行中获得98%的准确率。· 使用分配编码软件，NCCI,ICD-10,CPT,HCPCS 和 CMS 编码指南以准确审查，编码和纠正账户。·与部门管理人员合作报告，跟踪和解决拒绝。协助调查和审计纠正收费，编码以及结算合规则错误，包括确定根源原因，追踪趋势和进行适当的后续报告发现。· 工作多个分配付款人的工作队列，包括医疗保险，医疗补助，政府支付者，商业支付者،医疗福利计划和其他分配付款人的资金。· 研究有关授权，医疗必要性，非覆盖服务的纳税人拒绝，
查看英文原文
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
Key Responsibilities
- Manages clinical denials from clinical denial work queues, including claim resubmission, authorization verification, payer claim reprocessing, claim reconsiderations, and appeals.
- Works closely with the Managed Care team and payers to reduce denials and increase reimbursement.
- Develops recommendations for coding and documentation process improvements based on denial analysis and coding guidelines.
- Completes all tasks within productivity and accuracy standards, including meeting the assigned productivity goal of 30 worked accounts in an 8-hour scheduled work period with a 98% accuracy rate from assigned denial work queues.
- Uses assigned 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. Assists with investigations and audits to correct charging, coding, and billing compliance errors, including identifying root causes, tracking trends, and reporting findings for appropriate follow-up.
- Works multiple assigned payer work queues, including Medicare, Medicaid, government payers, commercial payers, Medicare Advantage plans, and other assigned payers.
- Researches payer denials related to authorization, medical necessity, non-covered services, coding, and billing that result in denials and payment delays. Initiates timely appeals with insurers to prevent timely filing denials.
- Submits detailed, customized reconsiderations and appeals to payers based on medical record review and established policies and procedures.
- Identifies denial patterns and escalates findings to management with sufficient information to support additional follow-up and root cause analysis.
- Reviews payer communications to identify reimbursement risks related to medical policies and prior authorization requirements.
- Reviews coding, applies modifiers, corrects diagnosis sequencing, and adds or removes codes as appropriate in accordance with coding guidelines to resolve coding denials.
- Reviews and adjusts charges as appropriate according to charging, documentation, and billing guidelines.
- Partners with departments to educate staff, improve processes, reduce denials, minimize charging errors, and decrease authorization-related denials.
- Analyzes denied claims to identify root causes and reimbursement issues.
Qualifications
Education
• High School Diploma or GED required.
- One of the following coding certifications required: CPC, COC, RHIT, RHIA, or CCS.
Experience & Skills
- One (1) to two (2) years of coding experience required.
- One (1) to two (2) years of denial management and/or insurance-related experience required.
Originally posted on Himalayas