Denial Recovery Coding Analyst | Enterprise Denials | Remote (must reside in FL, GA, PA, NC, SC[...]

UF Health; Gainesville (FL); Sur place; USD 50 000 - 70 000; Plein temps

Résumé du poste

A healthcare organization in Gainesville, Florida, seeks a dynamic denial management coding analyst to enhance coding effectiveness and reduce denials. The role involves analyzing denial trends, collaborating with various departments, and ensuring compliance with coding practices. Ideal candidates should have a high school diploma, relevant coding certification, and 1–2 years of experience. Strong analytical and organizational skills, along with proficiency in Microsoft Office, are essential for success in this position.

Qualifications

• 1-2 years of coding experience.
• 1-2 years of denial management and insurance experience.
• Experience in coding and medical record review preferred.

Responsabilités

• Support low denial rates and optimal reimbursement.
• Maintain high coding standards for accuracy.
• Lead projects to improve coding effectiveness.
• Analyze denial trends and coding validations.
• Educate departments on billing practices.
• Collaborate with teams to resolve reimbursement issues.

Connaissances

Knowledge of hospital billing and reimbursement

Critical thinking and analytical skills

Attention to detail

Organizational skills

Excellent communication skills

Proficiency in Microsoft Office applications

Knowledge of HIPAA guidelines

Problem-solving skills

Formation

High School Diploma or GED

Outils

Epic system

Microsoft Office

Description du poste

Overview

FTE: 1.0

Mon-Fri - 7:30 am to 4:30 pm

Serves as an enterprise-level dynamic denial management coding analyst focused on reducing denials, improving reimbursement, and maintaining high coding standards. Analyzes denial trends, Epic system edits, coding and CDM processes, authorization performance, and payer behaviors to drive improvements. Leads initiatives to enhance coding effectiveness and appeal turnaround times, while educating departments on compliant charging, billing, and coding practices. Collaborates with Managed Care and Compliance to resolve reimbursement and payer-related issues.

Responsibilities

Position Summary / Key Responsibilities

• Serves as the enterprise-level dynamic denial management coding analyst, supporting low denial rates and optimal reimbursement.
• Maintains high coding standards across the organization to ensure accuracy and compliance.
• Organizes, plans, and leads projects aimed at improving dynamic coding effectiveness, reimbursement performance, and appeal turnaround times.
• Performs detailed denial trend analyses, including:
  • Epic system edits
  • Coding validation
  • Charge Description Master (CDM) processes impacting reimbursement
  • Authorization trends and performance improvement
  • Payer-specific denial trends
• Educates departments on appropriate charging, billing, and coding practices to ensure regulatory compliance.
• Collaborates with Managed Care and Compliance teams to resolve coding, billing, and reimbursement issues with internal departments and external payers.

Qualifications

Required Education

• High School Diploma or GED

Required Licensure/Certification

• At least one of the following coding certifications is required:
• CPC, COC, CCS, CCS-P, CCA, CIC, RHIA, RHIT

Required Experience

• 1–2 years of coding experience
• 1–2 years of denial management and insurance experience

Preferred Experience

• Experience in coding, medical record review, auditing, and insurance processes

Necessary Skills

• Demonstrated knowledge of:
  • Hospital billing and reimbursement
  • Medicare and Medicaid denials and appeals
  • Third-party payer contracts
  • Federal and state healthcare regulations
• Strong critical thinking and analytical skills
• High attention to detail with the ability to work independently and minimize errors
• Proficient organizational and time-management skills
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office applications (Outlook, Word, Excel)
• Knowledge of HIPAA guidelines
• Ability to read and interpret Explanation of Benefits (EOBs)
• Strong research and problem-solving skills
• High level of comfort working with computer systems