Serves as the dynamic denial management coding analyst to maintain a low denial rate and high reimbursement rate at an enterprise level. This is to maintain a high coding standard within the enterprise. Organizes and plans projects to improve effectiveness of dynamic coding, reimbursement rates and appeal turnover rates. Performs analyses for denial trend improvement, including Epic system edits, coding validation, CDM processes that affect reimbursement, authorization trends, performance improvement and payer denial trends. Educates departments on appropriate charging/billing/coding issues to ensure regulatory compliance. Works with managed care and compliance to resolve issues with departments and payers.

Minimum Education and Experience Requirements:

• High school graduate required with CPC, COC, RHIT, RHIA, CCS and one to two years of coding experience, one to two years of insurance experience and denial experience.
• Associate's degree or higher in a health or business-related field and three years of coding or billing, insurance follow-up, collections or denial management in a hospital/clinical setting preferred.

Knowledge, Skills & Abilities:

• Demonstrated knowledge of:
  • Hospital billing and reimbursement
  • Denials and appeals
  • Third-party contracts
  • Federal and state regulations governing the health care industry
• Excellent critical thinking and analytical skills.
• Attention to detail and ability to complete the job with minimal errors and to work independently.
• Proficient organizational skills.
• Excellent writing and communication skills.
• Ability to prioritize and manage time effectively.
• Proficient in Microsoft Office products such as Outlook, Word and Excel.
• Knowledge of HIPPA guidelines.
• Ability to read and interpret EOBs.
• Strong research and problem-solving skills.
• High level of comfort with computer systems.