Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS codes in compliance with regulatory and payer requirements.
Work daily custom coding, pricing, and patient/client inquiry queues, as applicable, to ensure prior authorization requests and claims are coded accurately, have appropriate pricing and in are compliance with regulatory and payer requirements.
Investigate and resolve coding-related denials resulting in claim denials and delays in payment.
Identify and analyze coding denial patterns from worklists and collaborate cross functionally on strategies to reduce revenue leakage.
Collaborate with internal revenue cycle management teams to improve coding compliance.
Serve as a medical coding resource and subject matter expert for cross functional teams.
Participate in external audits to review coding integrity.
Monitor coding changes, regulatory updates, and payer policy changes.
Review reports on coding denials to support root cause analysis and coding accuracy.
Participate in ad hoc medical coding related tasks, projects, and inquiries as directed by leadership.
Complete other duties as assigned.

Associate’s degree in Business, Paralegal Studies, Coding, Communications, or other related field
Minimum 2 years of medical coding experience in inpatient, outpatient, or professional services, with exposure to denial management and revenue cycle analytics.
Strong knowledge of ICD-10-CM, CPT, HCPCS, medical terminology, payer guidelines, and reimbursement methodologies.
Proficiency in EHR systems, coding software, and Microsoft Excel for data analysis and coding audits.
Excellent analytical, communication, and problem-solving skills.
Knowledge of payer guidelines and reimbursement methodologies.
Ability to work independently and meet productivity/accuracy standards.
Experience with denial management tools and reporting systems.
Ability to interpret payer policies and regulatory requirements.
Strong attention to detail and ability to meet productivity and accuracy standards.
Experience working with third party payors.
Excellent oral and written communication skills.
Establish and maintain professional and cooperative relationships.
Effective human relations abilities.
Strong ability to effectively collaborative alliances and promote teamwork.

Coding and Denials Analyst

Key skills