Coding Denials Executive

Role & responsibilities

• Review and analyze coding denials for accuracy and completeness, ensuring adherence to current coding guidelines and payer requirements.
• Identify the root cause of denials related to coding issues and provide appropriate solutions for resolution.
• Collaborate with internal teams, such as coders, billers, and managers, to ensure timely correction of coding errors.
• Work closely with payers to address coding-related denials, appeals, and re-submissions.
• Update and maintain accurate records of all denied claims and resolutions in the system.
• Monitor trends in coding denials and provide recommendations for process improvements or training opportunities.
• Follow up on unresolved coding denials, ensuring that claims are re-submitted and payment is processed.
• Ensure compliance with regulatory and payer-specific coding requirements, as well as industry standards.
• Stay up-to-date with changes in coding guidelines and payer policies to avoid future denials.
• Assist with the preparation of denial reports and provide recommendations to improve the overall coding process.

Preferred candidate profile

• Ability to work independently and prioritize tasks effectively.
• Strong organizational and time management skills.
• Ability to handle high-volume tasks with attention to detail.
• Problem-solving skills and ability to resolve complex coding issues.
• Knowledge of HIPAA regulations and confidentiality standards.
• High School Diploma or equivalent (required); Associates degree or certification in Medical Coding (preferred).
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification (preferred).
• Minimum of 1 year of experience in medical coding or denial management within an RCM environment.
• Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.
• Experience with insurance payer policies and claims processing.
• Detail-oriented with excellent problem-solving and analytical skills.
• Strong communication skills and the ability to collaborate effectively with cross-functional teams.
• Proficiency with EHR/EMR systems and denial management software.