Multispecialty Denial Coder

4 weeks ago

Coimbatore, Tamil Nadu, India First source Full time
Job Description

Role & responsibilities

1. Denial Management & Analysis

- Review and analyze denied claims across multiple specialties.
- Identify root causes for denials (e.g., coding errors, documentation deficiencies, payer policies).
- Categorize denials based on common patterns (e.g., medical necessity, bundling issues, coding specificity).

2. Coding & Compliance

- Perform accurate medical coding for denied claims usingICD-10-CM, CPT, and HCPCScodes.
- Ensure coding compliance withCMS, payer guidelines, and HIPAA regulations.
- Work with physicians and medical teams to clarify documentation and correct coding issues.
- Stay updated on payer-specific coding rules and regulatory changes.

3. Claims Correction & Resubmission

- Correct coding errors and resubmit claims within payer timelines.
- Prepare appeals with supporting documentation, coding guidelines, and medical records.
- Communicate effectively with insurance companies to resolve claim disputes.

4. Documentation Improvement & Provider Education

- Provide feedback to physicians and clinical staff on documentation best practices.
- Conduct training sessions to reduce recurring coding errors and denials.
- Recommend process improvements to prevent future claim rejections.

5. Reporting & Performance Tracking

- Maintain records of denied claims, resolutions, and financial impact.
- Generate reports on denial trends, coding accuracy, and revenue recovery.
- Collaborate with revenue cycle teams to improve overall claim acceptance rates.

6. Cross-functional Collaboration

- Work closely withbilling teams, insurance follow-up specialists, and revenue cycle managers.
- Coordinate withcompliance officers and auditorsto ensure regulatory adherence.
- Communicate effectively withproviders, payers, and leadership teams.

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