Denial Recovery Coding Analyst | Revenue Integrity

UF Health•Gainesville, FL

1d•Remote

About The Position

Responsible for maintaining low denial rates and optimizing reimbursement across the enterprise by ensuring high coding standards and effective denial management practices. Leads and supports initiatives to improve coding accuracy, reimbursement outcomes, and appeal turnaround times. Performs in-depth analysis of denial trends, including Epic system edits, coding validation, Charge Description Master (CDM) processes, authorization trends, and payer denials. Identifies opportunities for performance improvement and implements strategies to enhance revenue cycle outcomes. Educates departments on appropriate charging, billing, and coding practices to ensure regulatory compliance. Collaborates with Managed Care, Compliance, and operational teams to resolve complex issues with departments and payers, driving sustainable improvements in reimbursement and denial prevention.

Requirements

High School Diploma or GED required
One of the following coding certifications required: CPC, COC, RHIT, RHIA, or CCS
1–2 years of coding experience
1–2 years of denial management and/or insurance-related experience

Responsibilities

Manages clinical denials from assigned work queues, including claim resubmissions, authorization verification, payer reprocessing, reconsiderations, and appeals
Partners closely with Managed Care and payers to reduce denials and improve reimbursement outcomes
Analyzes denial trends and develops recommendations to improve coding accuracy and documentation practices
Meets established productivity and accuracy standards, including reviewing approximately 30 accounts per day with a 98% accuracy rate
Applies coding guidelines (NCCI, ICD-10, CPT, HCPCS, CMS) to accurately review, code, and correct accounts
Collaborates with department managers to track, report, and resolve denials, including participating in audits and compliance reviews
Identifies root causes of denials, tracks trends, and escalates findings to leadership for follow-up and process improvement
Works across multiple payer work queues, including Medicare, Medicaid, government, and commercial payers
Research denials related to authorization, medical necessity, non-covered services, coding, and billing issues, ensuring timely resolution and appeal submission
Prepares and submits detailed, well-supported reconsiderations and appeals based on medical record review and payer requirements
Monitors payer communications and policy updates to identify risks impacting reimbursement and authorization requirements
Reviews and corrects coding, including modifier usage, diagnosis sequencing, and compliance with coding guidelines
Reviews and adjusts charges as needed based on documentation, billing, and regulatory standards
Educates departments on denial prevention strategies, including improvements in coding, charging, and authorization processes