HIS Coding Denial Analyst

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OCCUPATIONAL SUMMARY

The HIS Coding Denials Coordinator is responsible for evaluating and resolving denied claims within the Coding department under the direction of the HIS Coding Operations Manager. The HIS Coding Denial Coordinator works in conjunction with all other coding department personnel and other teams across the revenue cycle. This position is responsible for providing feedback using reports and data to the HIS System Administrator. The HIS Coding Denial Coordinator applies official coding guidelines, payer policies and established departmental policies and procedures to resolve claim rejections, and ensuring that timely filing deadlines have not been exceeded. The HIS Coding Denial Coordinator will provide training and education to coding staff and other teams across the revenue cycle regarding payer rejections.

PRIMARY DUTIES AND RESPONSIBILITIES 

1. Performs timely and accurate review of coding related denials, appeal and submission, including tracking findings.
2. Reviews medical record and coded information to determine if coding needs to be changed or if an appeal is needed for resolution.
3. Reviews all denial accounts for categorization, level of appeal, special requirements for initiating appeals.
4. Utilizes denial reports to assess root causes and identify trends.
5. Monitors and tracks denial trends to help identify education/feedback opportunities.
6. Maintains working knowledge of coding and billing regulations for all payers. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance and optimization.
7. In an environment of continuous quality improvement, the HIS Coding Denial Coordinator is responsible for the review of all denials to determine patterns in errors, payers, and internal processes to improve our denial rate.
8. Serves as the subject matter expert in the development and implementation of workflows within the Audit Manager software tool.
9. Work with Coding Assurance Coordinator to create and/or arrange training for coding staff regarding denials and insurance payers.
10. Performs other Coding functions as appropriate, including assisting with coding backlogs as necessary.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION REQUIRED

1. RHIT/RHIA/CCS/CPC with 5 years experience in coding for an acute care hospital.
2. Experience in CQI tools and techniques.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION PREFERRED

1. Master’s Degree
2. 5-10 years experience in acute care coding
3. Clinical Document Specialist/Clinical validation of coding experience
4. I-10 certified.