Coding Denial Specialist

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.

The Coding Denial Specialist is responsible for reviewing and analyzing denied claims related to coding and documentation issues. This role ensures accurate medical coding in compliance with federal regulations and payer-specific guidelines, while identifying trends and root causes of denials to reduce future occurrences. The specialist collaborates closely with coding staff, revenue cycle teams, and clinical departments to resolve issues, appeal denials, and support the financial health of the organization. 

Essential Duties:  

Denial Analysis & Resolution: 

• Review and analyze coding denials, including CPT, ICD-10, and HCPCS codes, to determine root causes. 
• Identify patterns in denials and implement corrective actions to prevent recurrence. 
• Collaborate with billing and clinical teams to rectify coding discrepancies. 
• Conduct audits of medical records to ensure coding accuracy and compliance with regulatory requirements. 

Appeals Management: 

• Prepare and submit comprehensive appeal letters with supporting documentation. 
• Ensure appeals are submitted within payer-specific timeframes. 
• Track and document the status of appeals until resolution. 

Compliance & Documentation: 

• Maintain up-to-date knowledge of coding guidelines, payer policies, and regulatory requirements. 
• Ensure all coding and billing activities comply with HIPAA and other relevant regulations. 
• Document all denial and appeal activities accurately in the system. 

Reporting & Communication: 

• Generate reports on denial trends and appeal outcomes for management review. 
• Communicate effectively with internal departments and external payers to resolve issues. 
• Provide feedback, training, and best practices for coding staff based on findings from denials. 
• Perform other related duties as assigned. 

Skills, Knowledge, Abilities:  

• Strong organizational skills with the ability to multi-task in a fast-paced environment.?? 
• Ability to adapt, modify and prioritize while adhering to strict deadlines and a willingness to shift priorities to meet the needs of the organization.  
• Knowledge and understanding of medical coding and billing systems and regulatory requirements. Knowledge of legal, regulatory and policy compliance issues related to medical coding and billing procedures and documentation.? 
• Excellent communication and interpersonal skills and demonstrated ability to interact with a variety of team members.  
• Self-motivated with the ability to identify opportunities for improvement and demonstrate the initiative to resolve issues in support of improvement efforts.?? 
• Strong analytical skills and the ability to work independently to analyze and solve problems.?? 
• Adept at learning proprietary software applications.? 
• Collaborate with professionals, internal and external to the company, and across geographic locations  
• Exhibit a growth mindset and team-oriented behaviors?? 
• Navigate competing priorities and effectively work in a fast-paced environment

Education:  

• Preferred: RHIA, CDI, CPC, CCS, CCS-P? 
• Bachelor’s degree or equivalent is required  
   

Experience:  

• Minimum of 2 years of experience in medical coding and billing, with a focus on denial management. 
• Familiarity with various payer guidelines, including Medicare and Medicaid. 

Certifications: 

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.