Coding Denials Specialist

Job Summary:

The Coding Denial Representative is responsible for reviewing the payor's denials and identifying the root cause of the denials account. The Coding Denial Representative determines if the account is appealable or not. 
Coding Denial Representative must understand and comply with the process established by the  Federal and State regulations, Payor's specific guidelines, Official Coding Guidelines, and be able to navigate the system properly. The Coding Denial Representative must ensure the confidentiality and 
privacy of information.

Essential Functions:

• Performs retrospective (post–discharge/post-service) medical record quality audits to 
  determine the appellate potential of claims with denied reimbursement related to Inpatient and 
  Outpatient coding data.
• Constructs and documents a succinct and fact-based case to support the appeal, utilizing 
  appropriate resources and medical record document(s) to support the appeal...