Insight Global is seeking a Coding Denials and Appeals Analyst to support a large healthcare system based out of Annapolis, MD. The Coding Denials and Appeals Analyst supports the denial management team by reviewing claims denied for coding-related root causes, as well as suggesting process improvements to reduce future denials.
Working closely alongside the denial management department, the coding denial analyst is a liaison between coding and the business office and communicates issues with missing documentation, inaccurate coding, and other trends causing denials.
Principal duties and responsibilities:
- Performs retrospective and prospective account reviews and resolves coding edits to ensure that coding is accurate, and documentation supports reimbursement.
- Analyzes coding-related denials (for problems such as bundling issues and inappropriate CPT/diagnoses) to identify trends and root causes.
- Develops process improvements for coding and documentation workflows based on denial analysis and industry coding guidelines.
- Organizes data into clear reports that are presented to denial management leadership, physician advisors, and providers.
- Provides regular feedback to denial management team members and coding/physician educators to promote departmental knowledge of best practices within coding.
- May assist with communication to providers on outstanding queries for additional documentation or diagnosis information.
- Proactively maintains current knowledge of applicable regulations and payer policy requirements, new or upcoming changes, and best practices from the AAP and professional journals.
- Supports the denial coding team with additional tasks as needed (such as directly inputting codes on complex or high-value accounts).
HYBRID SCHEDULE: Flexible hours with at least 2 days/week on site (Tues, Weds or Thurs) - Monday + Friday is REMOTE
Requirements:
- Associates Degree in business, healthcare, or related field
- At least 3 years of coding, denial management, and/or reimbursement experience (inpatient/outpatient)
- Current coding certification (RHIA, RHIT, CPC, CCS)
Preferred Qualifications:
- Bachelor's Degree in business, healthcare, or related field.
