About the role
OverviewWork 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.
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- 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. ResponsibilitiesKey ResponsibilitiesManages clinical denials from assigned denial workqueues, including claim resubmissions, authorization verification, payer claim reprocessing, reconsiderations, and appeals.Partners with managed care teams and payers to reduce denials and maximize reimbursement.Identifies opportunities to improve coding and clinical documentation based on denial trends and coding guidelines.Meets established productivity and quality standards while managing assigned denial workqueues.Reviews and corrects accounts using coding software, NCCI, ICD-10, CPT, HCPCS, and CMS coding guidelines.Collaborates with department leadership to investigate, track, trend, and resolve coding, charging, billing, and compliance issues.Manages multiple payer workqueues, including Medicare, Medicaid, Medicare Advantage, commercial, and government payers.Researches denials related to authorization, medical necessity, coding, billing, non-covered services, and documentation, initiating timely appeals to prevent filing deadline issues.Prepares detailed reconsiderations and appeal submissions based on medical record review and organizational policies.Identifies payer-specific denial trends, performs root cause analysis, and escalates findings to management for corrective action.Reviews payer communications to identify reimbursement risks related to medical policies and prior authorization requirements.Reviews and corrects coding, modifiers, diagnosis sequencing, and charges in accordance with coding, charging, documentation, and billing guidelines.Partners with operational departments to educate staff, improve documentation and authorization practices, reduce denials, and strengthen overall revenue cycle performance. QualificationsEducation
- High School Diploma or GED required.
- One of the following coding certifications required: CPC, COC, RHIT, RHIA, or CCS.
- 1–2 years of medical coding experience.1–2 years of denial management and/or health insurance experience. Preferred
- One (2) to three (3) years of coding experience required.
- One (1) to three (3) years of denial management and/or insurance-related experience required.
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