Coding Denials and Appeals Specialist

The Coding Denials and Appeals Specialist is responsible for ensuring that workflows, processes, and data align with regulatory and payer requirements. This role focuses on reviewing and resolving clinical and medical-necessity denials for outpatient professional and facility services by identifying and correcting coding errors and ensuring compliance with applicable guidelines.

Key responsibilities

• Review, analyze, and resolve clinical and medical-necessity denials for outpatient professional and facility services.
• Identify and correct coding discrepancies to support accurate billing, compliant documentation, and appropriate reimbursement.
• Collaborate with coding, billing, and revenue cycle teams to address denial trends and improve coding accuracy.
• Participate in post-billed account reviews and post-payment audits to support recovery efforts and reduce preventable denials.
• Use denial trends and coding data to recommend process improvements and denial prevention strategies.
• Support coding education efforts based on denial findings, coding errors, and documentation improvement opportunities.
• Maintain current knowledge of payer policies, regulatory requirements, and coding standards.
• Document denial activities, corrections, and follow-up actions in accordance with organizational policies.
• Support special projects, audits, and initiatives related to coding quality, compliance, and revenue integrity.