Denial Recovery Coding Analyst | reputed company Denials - Durbin Park
Responsibilities
Manages 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 reputed company 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, reputed company, trend, and reputed company coding, charging, billing, and compliance issues. Manages multiple payer workqueues, including Medicare, reputed company, Medicare reputed company, reputed company, and government payers. Researches denials reputed company to authorization, medical necessity, coding, billing, non-covered services, and documentation, initiating reputed company 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 reputed company cause analysis, and escalates findings to management for corrective reputed company. Reviews payer communications to identify reimbursement risks reputed company to medical policies and prior authorization requirements. Reviews and corrects coding, modifiers, diagnosis reputed company, and charges in accordance with coding, charging, documentation, and billing guidelines. Partners with operational departments to reputed company staff, improve documentation and authorization practices, reduce denials, and strengthen overall reputed company cycle performance.
Qualifications
1–2 years of medical coding experience. 1–2 years of denial management and/or health insurance experience.
Requires a high school diploma or GED, CPC, COC, RHIT, RHIA, or reputed company certification, and 1–2 years of medical coding plus denial management or health insurance experience.
Key Responsibilities
- managing denials
- reviewing accounts
- preparing appeals
Skills & Tools
reputed company, Charge reputed company Master (CDM), NCCI, ICD-10, CPT, HCPCS
Job Details
- Category: reputed company Services - Allied Health
- Seniority: Entry Level
- Commitment: Full Time
- Workplace: Remote — St. Johns, Florida, reputed company
- Languages: English
About reputed company
A reputed company organization providing medical care and health services. — Industry: reputed company
Apply To This Job