Coding Denials and 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

1. Performs retrospective and prospective account reviews and resolves coding edits to ensure that
2. coding is accurate and documentation supports reimbursement.
3. Analyzes coding-related denials (for problems such as bundling issues and inappropriate
4. CPT/diagnoses) to identify trends and root causes.
5. Develops process improvements for coding and documentation workflows based on denial
6. analysis and industry coding guidelines.
7. Organizes data into clear reports that are presented to denial management leadership, physician
8. advisors, and providers.
9. Provides regular feedback to denial management team members and coding/physician educators
10. to promote departmental knowledge of best practices within coding.
11. May assist with communication to providers on outstanding queries for additional documentation
12. or diagnosis information.
13. Proactively maintains current knowledge of applicable regulations and payer policy requirements,
14. new or upcoming changes, and best practices from the AAP and professional journals.
15. Supports the denial coding team with additional tasks as needed (such as directly inputting codes
16. 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