Denial Coding Specialist

Who We Are Xtensys, a recently established managed service provider, delivers cutting-edge technology to health systems, starting in NY and expanding beyond. Owned by two industry leaders focused on innovation in rural and community health, we are rapidly growing with several major initiatives underway. We are seeking an experienced Denial Coding Specialist to join our team of 500 and support our exciting journey. We value people and we’re building a culture to match. If you are a collaborative, innovative, and strategic leader, we’d love to talk. Job Summary The Denial Coding Specialist plays a critical role in the Revenue Cycle team, responsible for managing coding denial review and appeal processes. This role involves evaluating coding guidelines, claims recovery, and root cause analysis of denials. The Coding Denial Specialist collaborates with various departments to ensure a comprehensive denial management process, addressing any revenue cycle issues contributing to denial.

Key Responsibilities

• Denial Review & Appeal Management: Make preliminary determinations on whether coding denials can be recovered and assess the need for further appeal submissions.
• Research & Documentation: Research and prepare appeal files in response to coding denials, ensuring all necessary documentation and support are included.
• Root Cause Analysis: Analyze coding denials to identify underlying issues and work towards resolving them effectively.
• Resolution of Denials: Resolve coding and benefit exhausted denials by researching payer guidelines, preparing appeals, and submitting them as necessary.
• Escalation of Errors: Identify coding, billing, or reimbursement errors within denied or aging claims and escalate to the CHS Director of Denials for further action.
• Reimbursement Evaluation: Assess denied dollars in comparison to expected reimbursements, identifying discrepancies and discrepancies in payments.
• Medical Necessity Review: Review denials requiring coding or medical necessity evaluations and prepare appeal responses.
• Tracking & Trend Analysis: Track and trend denial issues, escalating to leadership to assist with process improvements.
• Special Projects: Participate in special projects as assigned to improve denial management processes.

Skills and Experience

• Minimum of 5 years of coding experience.
• Extensive knowledge of the managed care industry, payer structures, and government payers.
• Proficient understanding of National Correct Coding Initiative (NCCI).
• Deep knowledge of insurance reimbursement, billing concepts, and payment compliance regulations, including denials and appeals recovery.
• Knowledge of various reimbursement methodologies, such as PerDiem, DRG, fee schedules, percentage of charges, and stop loss.
• Proficient in medical coding systems impacting claims payment adjudication, including ICD9, CPT, HCPCS, DRG, APG, APC, and revenue code structures.
• Strong problemsolving skills with the ability to anticipate obstacles and proactively resolve them.
• Excellent collaboration skills, capable of working independently or within a team environment.
• Strong initiative to identify process barriers and provide operational improvements.
• Exceptional investigation, analytical, and attentiontodetail skills.
• Effective verbal and written communication abilities.
• Ability to prioritize tasks, ensuring timely and accurate completion of work.
• Quick adaptability to changes in processes or requirements.
• Knowledge of industry standard criteria (e.g., Interqual, Milliman Care Guidelines, NCCN).
• Capacity to build effective relationships across the system, contributing to team success.
• Strong motivation to participate in the ongoing growth and development of Denial Management.

Education/Certifications

• Bachelor’s degree, or equivalent experience (preferred).
• Licensure/Certifications: CPC Certified Professional Coder, COCCertified Outpatient Coder and/or CICCertified Inpatient Coder required.

Travel Requirements

• None

Physical Requirements

• Ability to lift up to 20 pounds.
• Ability to stand or sit for extended periods.
• Frequent use of hands and fingers for typing and computer work.

About Xtensys Connected Health Solutions We are new but mighty. Xtensys, a recently established managed service provider, delivers cutting-edge technology to health systems, starting in NY and expanding beyond. Owned by two industry leaders focused on innovation in rural and community health, we are rapidly growing with several major initiatives underway. We seek talented professionals to join our team of 500 and support our exciting journey. We value people and are building a culture to match. If you're a collaborative, innovative, and strategic leader, we’d love to talk. Apply tot his job