Denial Recovery Coding Analyst | Enterprise Denials

Overview

FTE: 1.0
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Position Summary: The Denial Management Coding Analyst plays a key role in maintaining low denial rates and high reimbursement rates at an enterprise level, while ensuring adherence to high coding standards across the organization. This position is responsible for organizing and planning projects aimed at improving coding effectiveness, optimizing reimbursement, and reducing appeal turnaround times.

• Analyze denial trends, including EPIC system edits, coding validation, CDM processes affecting reimbursement, authorization trends, and payer denial patterns, to drive performance improvement.

• Educate departments on appropriate charging, billing, and coding practices to ensure regulatory compliance.

• Collaborate with Managed Care and Compliance teams to resolve coding, billing, and denial issues with departments and payers.

• Plan and implement projects to enhance dynamic coding efficiency, reimbursement rates, and appeal processes.

Minimum

Education and Experience Requirements:

• Required: High school graduate with one or more of the following certifications: CPC, COC, CCS, CCS-P, CCA, CIC, RHIA, RHIT.

• Experience
  
  Required:
  
  

  • 1–2 years coding experience

  • 1–2 years insurance experience

  • Denial experience

• Preferred: Associate’s degree or higher in a health- or business-related field, with 3 years of experience in coding or billing, insurance follow-up, collections, or denial management in a hospital/clinical setting.

Knowledge, Skills, and Abilities:

• Demonstrated knowledge of:

  • Hospital billing and reimbursement

  • Denials and appeals

  • Third-party contracts

  • Federal and state regulations governing the healthcare industry

• Excellent critical thinking and analytical skills

• Attention to detail and ability to complete tasks with minimal errors and independently

• Proficient organizational skills

• Excellent writing and communication skills

• Ability to prioritize and manage time effectively

• Proficient in Microsoft Office products (Outlook, Word, Excel)

• Knowledge of HIPAA guidelines

• Ability to read and interpret Explanation of Benefits (EOBs)

• Strong research and problem-solving skills

• High level of comfort with computer systems

Motor Vehicle Operator Designation:

• Will not operate vehicles for an assigned business purpose

Licensure/Certification/Registration:

• None