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 assigned work queues, including claim resubmissions, authorization verification, payer reprocessing, reconsiderations, and appeals Partners closely with Managed Care and payers to reduce denials and improve reimbursement outcomes Analyzes denial trends and develops recommendations to improve coding accuracy and documentation practices Meets established productivity and accuracy standards, including reviewing approximately 30 accounts per day with a 98% accuracy rate Applies coding guidelines (NCCI, ICD-10, CPT, HCPCS, CMS) to accurately review, code, and correct accounts Collaborates with department managers to track, report, and resolve denials, including participating in audits and compliance reviews Identifies root causes of denials, tracks trends, and escalates findings to leadership for follow-up and process improvement Works across multiple payer work queues, including Medicare, Medicaid, government, and commercial payers Research denials related to authorization, medical necessity, non-covered services, coding, and billing issues, ensuring timely resolution and appeal submission Prepares and submits detailed, well-supported reconsiderations and appeals based on medical record review and payer requirements Monitors payer communications and policy updates to identify risks impacting reimbursement and authorization requirements Reviews and corrects coding, including modifier usage, diagnosis sequencing, and compliance with coding guidelines Reviews and adjusts charges as needed based on documentation, billing, and regulatory standards Educates departments on denial prevention strategies, including improvements in coding, charging, and authorization processes

Qualifications

Minimum Qualifications: High School Diploma or GED required One of the following coding certifications required: CPC, COC, RHIT, RHIA, or CCS 1–2 years of coding experience, along with 1–2 years of denial management and/or insurance-related experience