Coding Compliance and Denials Manager - FT - Days

Vitruvian Health•Dalton, GA

About The Position

The HIM Manager of Coding Compliance and Denials Management performs advanced work in clinical and DRG denial management. The manager handles denials involving referrals, authorizations, notifications, non-coverage, medical necessity, DRGs, and other assigned areas. They review medical necessity and DRG denials and medical records to determine whether to submit a revised claim, obtain retroactive authorization, prepare a written appeal, or take no action. They write and submit timely, well-supported appeals using clinical documentation, third-party payer medical policies, and contract language, and track appeals through their final outcomes. The manager monitors and communicates denial and appeal activity to stakeholders, reports suspected or emerging payer-denial trends to Revenue Cycle management, and performs audit, compliance, and administrative duties. Working independently, they organize activities affecting hospital and physician reimbursement, help document key processes, and support efforts to secure reimbursement and minimize write-offs. The role assists the HIM Director in planning, organizing, directing, and coordinating Coding Compliance functions for Coding and CDI. Responsibilities include project management for HIM systems, application support and software maintenance, system documentation and quality initiatives, status updates, daily work-queue review, and assistance with internal and external coding audits. The manager also codes, analyzes, and abstracts medical records using established classification systems and enters abstracted information into the hospital financial system. They identify poor-quality, incorrectly positioned, or misindexed scanned documents and refer issues for correction. The position participates in assigned departmental on-call coverage.

Requirements

Graduate of an approved RHIA or RHIT program.
Current RHIA, RHIT, or RN licensure.
Three years of experience in a healthcare revenue cycle or clinic operations role, including at least one year in a role involving denial appeal writing.
Experience with medical and insurance terminology, CPT and ICD coding structures, and UB and 1500 billing forms.
Knowledge of medical terminology, anatomy and physiology, DRG and APC assignment, and ICD-10-CM/PCS, CPT, and E/M coding systems.
Knowledge of Medicare, Medicaid, and third-party reimbursement methodologies.
Knowledge of local, state, and federal healthcare regulations.
Broad knowledge of healthcare business office practices and principles, basic math, and general accounting principles.
Ability to write professional appeal letters and organize details logically and accurately.
Strong written and verbal communication skills, including the ability to communicate with managers, physicians, clinical staff, support staff, and external stakeholders.
Ability to listen empathetically and maintain strong relationships with clinical and non-clinical team members.
Ability to work independently with minimal direction, manage multiple tasks, set priorities, and remain result-oriented during demanding or high-volume periods.
Strong judgment, problem-solving, organizational, technical, interpersonal, and teamwork skills.
Ability to respond to frequent changes in duties and workload and maintain a positive, service-oriented approach.
Ability to promote customer satisfaction among employees, patients, visitors, faculty, referring physicians, and external stakeholders.
Excellent PC operating skills, including keyboard and mouse use, and ability to use MS Office and other computer applications.
Ability to maintain confidentiality of sensitive information.
Ability to participate in alternating on-call coverage.

Nice To Haves

Epic experience.

Responsibilities

Manage clinical, DRG, referral, authorization, notification, non-coverage, medical necessity, and other assigned denials.
Review denial cases and medical records to determine appropriate next steps, including claim revision, retroactive authorization, written appeal, or no action.
Write and submit timely, professionally written appeals supported by clinical documentation, payer medical policies, and contract language; track appeals through final outcomes.
Manage, maintain, and communicate denial and appeal activity to appropriate stakeholders and report payer-denial trends to Revenue Cycle management.
Perform audit-related, compliance, and administrative duties.
Plan, schedule, organize, and document activities that affect hospital and physician reimbursement.
Assist the HIM Director with planning, organizing, directing, and coordinating HIM Coding Compliance functions for Coding and CDI.
Perform project management activities for HIM systems, including action plans, design specifics, and budget requirements.
Provide application support for HIM systems, maintain and update supported software, and coordinate system documentation and quality initiatives.
Provide periodic status updates to the HIM Director and review assigned work queues daily to ensure timely processing.
Assist with internal and external coding audits.
Code, analyze, and abstract medical records according to established classification systems and enter the information into the hospital financial system.
Identify poor-quality documents and scanning or indexing errors, and refer them to appropriate scanning or quality-control staff for correction.
Participate in departmental on-call coverage during assigned weeks and provide assistance at other times as needed.