Coding Denials & Appeals Specialist
Position summary
The coding denial analyst supports the denial management team by reviewing claims denied for coding-related root causes, as well as suggesting process improvements to reduce future denials.
Working closely alongside the denial management department, the coding denial analyst is a liaison between coding and the business office and communicates issues with missing documentation, inaccurate coding, and other trends causing denials.
Principal duties and responsibilities
- Performs retrospective and prospective account reviews and resolves coding edits to ensure that
- coding is accurate and documentation supports reimbursement.
- Analyzes coding-related denials (for problems such as bundling issues and inappropriate
- CPT/diagnoses) to identify trends and root causes.
- Develops process improvements for coding and documentation workflows based on denial
- analysis and industry coding guidelines.
- Organizes data into clear reports that are presented to denial management leadership, physician
- advisors, and providers.
- Provides regular feedback to denial management team members and coding/physician educators
- to promote departmental knowledge of best practices within coding.
- May assist with communication to providers on outstanding queries for additional documentation
- or diagnosis information.
- Proactively maintains current knowledge of applicable regulations and payer policy requirements,
- new or upcoming changes, and best practices from the AAP and professional journals.
- Supports the denial coding team with additional tasks as needed (such as directly inputting codes
- on complex or high-value accounts).
Position qualifications
Education
- Associate degree in business, healthcare, or related field is required.
- Current coding certification (RHIA, RHIT, CPC, CCS) is required.
- Bachelor’s degree in health information management, business, healthcare, or related field is preferred.
Experience
- Three years of medical coding, denial management, and/or reimbursement experience is required
Luminis Health Benefits Overview:
• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more
*Benefit offerings based on employment status
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