Denial Recovery Coding Analyst | Enterprise Denials - Durbin Park

Key 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 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.

Minimum Qualifications

• 1–2 years of medical coding experience.
• 1–2 years of denial management and/or health insurance experience.