Denial Coder/Coding Denials Specialist

Role & responsibilities

• Denial Review & Research:
• Review and research denied claims to identify coding-related issues, including no payment or previously submitted claims with no response.
• Investigate the root causes of coding denials and resubmit claims accordingly.
• Maintain accurate records and log all denial trends and increases for future analysis.
• Appeals & Reconsideration:
• Initiate and respond to coding appeals in a timely manner, ensuring that all necessary steps are taken for claim reconsideration.
• Collaborate with internal teams to obtain medical records, payer requirements, and other necessary information for appeal submissions.
• Collaboration & Communication:
• Work closely with coding and billing teams, as well as customer service, to minimize coding denials.
• Communicate denial trends to leadership and peers, providing feedback and recommendations for corrective action.
• Answer management and customer service emails, ensuring all coding-related inquiries are addressed.
• Compliance & Accuracy:
• Ensure compliance with ICD-10-CM, CPT, HCPCS codes, and payer requirements.
• Meet monthly productivity goals with an accuracy rate of 95% or higher on audits.
• Adhere to company policies, procedures, and HIPAA confidentiality standards.
• Training & Education:
• Identify coding denial trends and provide educational materials or guidance to reduce future denials.
• Support the development of preventative measures based on claim denial patterns and data.
• Other Responsibilities:
• Participate in special projects as assigned by leadership.
• Maintain and utilize current coding resource materials when making determinations for claim reconsiderations.
• Complete other tasks as related to the overall goals of the department.

Required Skills & Qualifications:

• Experience:
• At least 3 years of previous coding experience in specialties such as orthopedics, ophthalmology, neurology, trauma, and more is preferred.
• Advanced knowledge of radiology, orthopedics (including spine, upper and lower extremities, and sports medicine), and pain management, and other related coding fields is highly desired.
• Certifications:
• AAPC or AHIMA is required (CCS, RHIT, or RHIA).
• Knowledge of current coding materials such as CPT and ICD-10-CM is required.
• Technical Skills:
• Proficiency in Microsoft Office and data entry skills (40 WPM minimum).
• Experience with systems such as EMR, billing, and scheduling tools.
• Familiarity with payer requirements, including LCD/NCD Lists.
• Personal Attributes:
• Strong problem-solving skills and attention to detail.
• Ability to work independently, meet deadlines, and manage time effectively.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality and comply with HIPAA regulations.

• Preferred Candidates: Immediate joiners.