Denial Recovery Coding Analyst | Enterpirse Denials

UF Health•Gainesville, FL

17h•Remote

About The Position

The Denial Recovery Coding Analyst is a full-time, remote role responsible for maintaining low denial rates and optimizing reimbursement across the enterprise through high coding standards and effective denial management. The analyst supports initiatives to improve coding accuracy, reimbursement outcomes, and appeal turnaround times. The role analyzes denial trends involving Epic system edits, coding validation, Charge Description Master (CDM) processes, authorization trends, and payer denials. It identifies performance improvement opportunities and implements strategies to improve revenue cycle outcomes. The analyst also educates departments on appropriate charging, billing, and coding practices to support regulatory compliance, and collaborates with Managed Care, Compliance, operational teams, departments, and payers to resolve complex issues and drive lasting improvements in reimbursement and denial prevention. The position is remote and limited to applicants residing in Florida, Georgia, Pennsylvania, North Carolina, South Carolina, Tennessee, or Texas. The scheduled productivity goal is 30 worked accounts per 8-hour work period with a 98% accuracy rate.

Requirements

High school diploma or GED.
One of the following coding certifications: CPC, COC, RHIT, RHIA, or CCS.
One to two years of coding experience.
One to two years of denial management and/or insurance-related experience.

Responsibilities

Manage clinical denials from clinical denial work queues, including claim resubmission, authorization verification, payer claim reprocessing, claim reconsiderations, and appeals.
Work with the Managed Care team and payers to reduce denials and increase reimbursement.
Develop recommendations for coding and documentation process improvements based on denial analysis and coding guidelines.
Meet productivity and accuracy standards, including 30 worked accounts in an 8-hour scheduled work period and a 98% accuracy rate.
Use assigned coding software, NCCI, ICD-10, CPT, HCPCS, and CMS coding guidelines to review, code, and correct accounts.
Collaborate with department managers to report, track, and resolve denials; assist with investigations and audits; identify root causes and trends; and report findings for follow-up.
Work assigned payer queues, including Medicare, Medicaid, government payers, commercial payers, Medicare Advantage plans, and other assigned payers.
Research denials related to authorization, medical necessity, non-covered services, coding, and billing, and initiate timely appeals to prevent timely filing denials.
Prepare detailed, customized payer reconsiderations and appeals based on medical record review and established policies and procedures.
Identify denial patterns and escalate findings to management with information supporting follow-up and root cause analysis.
Review payer communications to identify reimbursement risks related to medical policies and prior authorization requirements.
Review coding, apply modifiers, correct diagnosis sequencing, and add or remove codes as appropriate under coding guidelines to resolve coding denials.
Review and adjust charges according to charging, documentation, and billing guidelines.
Partner with departments to educate staff, improve processes, reduce denials and charging errors, and decrease authorization-related denials.
Analyze denied claims to identify root causes and reimbursement issues.