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 related to clinical and DRG denial management. The role manages denials involving referrals, authorizations, notifications, non-coverage, medical necessity, DRGs, and other assigned areas. The manager reviews medical necessity and DRG denials and medical records to determine whether to submit a revised claim, obtain retroactive authorization, submit a written appeal, or take no action. The manager prepares and submits timely, professionally written appeals grounded in clinical documentation, payer medical policies, and contract language, and tracks appeals through their final outcomes. The manager oversees denial and appeal activity, communicates it to relevant stakeholders, reports suspected or emerging payer-denial trends to Revenue Cycle management, and performs audit, compliance, and administrative duties. Working independently, the manager plans and organizes activities affecting hospital and physician reimbursement, helps maintain documentation of key processes, and supports efforts to secure reimbursement and minimize write-offs. The role assists the HIM Director in planning, organizing, directing, and coordinating HIM Coding Compliance functions for Coding and CDI. It performs project management for HIM systems, including developing action plans, design details, and budget requirements; provides application support; maintains and updates supported software; and coordinates system documentation and quality initiatives. The manager provides status updates to the HIM Director and ensures assigned work queues are processed promptly. Other duties include assisting with internal and external coding audits; coding, analyzing, and abstracting medical records according to established classification systems; entering abstracted information into the hospital financial system; identifying poor-quality or incorrectly positioned documents; ensuring documents are indexed to the correct patient and encounter; and referring issues to scanning or quality-control staff. The manager participates in department on-call coverage during assigned weeks and provides assistance at other times as needed.

Requirements

Graduate of an approved RHIA or RHIT program.
Current RHIA, RHIT, or RN credential.
Three years of experience in a healthcare revenue cycle or clinic operations role, including 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 and local, state, and federal healthcare regulations.
Knowledge of healthcare business-office practices and principles, basic math, and general accounting principles.
Strong writing skills, including the ability to prepare professional appeal letters and organize details logically and accurately.
Effective verbal and written communication skills with managers, physicians, clinical and support staff, and external stakeholders.
Ability to maintain strong relationships with clinical and non-clinical team members to positively affect financial outcomes.
Ability to work independently with minimal direction, manage multiple tasks, set priorities, and exercise sound judgment during demanding or high-stress periods.
Detail-oriented, service-oriented, self-motivated, and results-oriented, with organizational, technical, problem-solving, and interpersonal skills.
Ability to adapt to frequent changes in duties and workload and maintain a sense of urgency and a positive attitude.
Ability to promote teamwork, listen empathetically, and support a high level of customer satisfaction.
Excellent PC operating skills, including keyboard and mouse use, and ability to use various computer applications and MS Office.
Ability to maintain confidentiality of sensitive information.
Willingness to participate in alternating on-call coverage.

Nice To Haves

Epic experience.

Responsibilities

Manage clinical, DRG, medical necessity, referral, authorization, notification, non-coverage, and other assigned denials.
Review denial cases and medical records to determine whether to revise claims, obtain retroactive authorization, submit an appeal, or take no action.
Write, submit, and track timely, professional appeals based on clinical documentation, payer medical policies, and contract language.
Manage, maintain, and communicate denial and appeal activity to stakeholders, and report suspected or emerging payer-denial trends to Revenue Cycle management.
Perform audit-related, compliance, and administrative duties.
Plan and organize work that affects hospital and physician reimbursement, and assist in documenting key processes.
Assist the HIM Director with planning, organizing, directing, and coordinating HIM Coding Compliance functions for Coding and CDI.
Manage HIM systems projects, including action plans, design specifics, budget requirements, and project execution.
Provide application support for HIM information systems and maintain and update supported software.
Initiate and coordinate system documentation and quality initiatives, and provide periodic status updates to the HIM Director.
Review assigned work queues daily and ensure timely processing.
Assist with internal and external coding audits.
Code, analyze, and abstract medical records and enter abstracted information into the hospital financial system.
Identify poor-quality, incorrectly positioned, or incorrectly indexed scanned documents and refer issues to scanning or quality-control staff for correction.
Participate in department on-call coverage during assigned weeks and help when needed at other times.