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Luminis Health · 2 months ago

Coding Denials & Appeals Specialist

Annapolis, MD

Full-time

Onsite

Mid Level

$33/hr - $42/hr

3+ years exp

Luminis Health is a healthcare organization, and they are seeking a Coding Denials & Appeals Specialist to support their denial management team. This role involves reviewing claims denied for coding-related reasons and suggesting process improvements to minimize future denials.

Health CareMedicalNon Profit

Responsibilities

Performs retrospective and prospective account reviews and resolves coding edits to ensure that coding is accurate and documentation supports reimbursement

Analyzes coding-related denials (for problems such as bundling issues and inappropriate CPT/diagnoses) to identify trends and root causes

Develops process improvements for coding and documentation workflows based on denial analysis and industry coding guidelines

Organizes data into clear reports that are presented to denial management leadership, physician advisors, and providers

Provides regular feedback to denial management team members and coding/physician educators to promote departmental knowledge of best practices within coding

May assist with communication to providers on outstanding queries for additional documentation or diagnosis information

Proactively maintains current knowledge of applicable regulations and payer policy requirements, new or upcoming changes, and best practices from the AAP and professional journals

Supports the denial coding team with additional tasks as needed (such as directly inputting codes on complex or high-value accounts)