Title: Mid Rev Cycle Integrity Denial Analyst

Location: Remote

Duration: 6 months w/ Extension

Primary Purpose

The Mid Revenue Cycle Integrity Coding Denial Analyst is responsible for consistently analyzing coding accounts receivable (AR), resolving coding denials, and addressing customer service requests to ensure accurate, compliant coding and appropriate reimbursement. This role supports either professional-based coding (PB) or hospital-based coding (HB) workflows. The analyst monitors patterns and trends in rejection codes, communicates outcomes and obstacles to leadership, and supports the department’s compliance plan by adhering to coding and payer standards to minimize denials and optimize revenue integrity.

Major Responsibilities (Professional Based Coding or Hospital Based Coding)

Denial Resolution and Analysis

• Analyze coding-related AR and resolve denials for either PB or HB using CPT, HCPCS, ICD-10-CM, and modifiers.
• Investigate root causes of denials and identify patterns or trends in rejection codes.
• Collaborate with billing, coding, and payer teams to correct and resubmit claims.
• Conduct chart reviews to compare documentation against billed services.

Appeals and Documentation Support

• Prepare appeals by researching payor guidelines and coding standards.
• Ensure claims are coded accurately and sequenced according to AHA Coding Clinic, CPT Assistant, and coverage decisions.
• Maintain documentation of denial resolutions and appeal outcomes.

Compliance and Quality Assurance

• Adhere to official coding guidelines and payer standards to ensure compliant coding.
• Monitor coding accuracy and quality, track issues, and resolve escalations.
• Support the department’s compliance plan and contribute to revenue integrity.

Education and Collaboration

• Share findings with clinicians and coders to improve documentation and coding practices.
• Work with education teams to develop training based on denial trends.
• Respond to customer service inquiries related to coding issues.

Operational and Strategic Contributions

• Participate in denial avoidance strategy planning and implementation.
• Support organizational goals such as reducing denials by targeted amounts.
• Help redesign work queues and map CARC codes to align with enterprise service lines.

Technology and Training Recommendations

• Utilize specialized software platforms to efficiently track, manage, and analyze denied claims, ensuring timely resolution and accurate documentation.
• Recommend targeted staff training initiatives to proactively prevent future denials and uphold regulatory compliance standards.

Preferred Job Requirements:

Education

• Associate degree or equivalent education and experience required.

Certification / License

• A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant experience.

Work Experience

• 4 years of experience in expert-level professional coding or hospital-based coding and experience in revenue cycle processes, health information workflows, and medical record auditing experience

Knowledge / Skills / Abilities

• Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents.
• Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications.
• Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Advanced analytical skills, with great attention to detail.
• Self-motivated with initiative and strong sense of ethics.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.