Medasource
Title:
Outpatient Denials Coder (Mid Revenue Cycle Integrity Analyst) Location:
100% Remote Duration:
6 months with possible extension
Major Responsibilities Reviews and analyzes outpatient medical record documentation, coding, and billing data to identify root causes of coding‐related denials, underpayments, and reimbursement variances. Investigates payer denials by evaluating CPT/HCPCS codes, ICD-10-CM diagnoses, modifiers, NCCI edits, medical necessity requirements, and payer-specific coding/billing rules. Prepares accurate and timely appeals with supporting documentation to overturn inappropriate denials and recover reimbursement. Identifies trends in denials and collaborates with coding leadership, clinical departments, billing teams, and revenue cycle partners to address systemic issues and reduce future denials. Performs detailed audit and reconciliation of coded claims to ensure compliance with regulatory and payer guidelines, including Medicare, Medicaid, and commercial policies. Participates in process-improvement initiatives related to charge capture, documentation workflows, coding accuracy, and denial prevention. Develops and maintains documentation of denials workflows, appeal templates, root-cause analysis results, and process improvements. Monitors key performance indicators (KPIs) related to denial rates, appeal success rates, coder accuracy, and timely filing requirements. Assists in training or educating outpatient providers, coding staff, and operational teams on denial trends, coding accuracy, documentation needs, and payer policy updates. Works closely with revenue cycle teams to ensure timely submission, tracking, and resolution of claims and appeals. Supports the development and optimization of outpatient coding/denial workflows by helping translate operational needs into process improvements and ensuring accurate data tracking.
Licensure, Registration, and/or Certification Required Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Outpatient Coder (COC) required. Additional AHIMA or AAPC certifications preferred.
Education Required Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, Coding, or related field
Experience Required Typically requires
3+ years of outpatient coding experience , including CPT/HCPCS, ICD-10-CM, and modifier application. Experience reviewing, appealing, and resolving outpatient coding denials strongly preferred. Familiarity with payer policies, medical necessity standards, NCCI edits, and reimbursement methodologies (APCs, OPPS, etc.).
Knowledge, Skills & Abilities Required Strong working knowledge of outpatient coding guidelines, CMS policies, and commercial payer requirements. Experience interpreting denial codes, remittance advice (RAs/EOBs), and root-cause identification. Analytical skills required to evaluate denial trends and make data-driven recommendations for process improvement. Strong written communication skills for preparing clear, effective appeal letters. Ability to manage multiple cases, prioritize deadlines, and work independently in a remote environment. Intermediate computer skills, including use of EMRs, encoder tools, claim scrubbers, denial management systems, and Microsoft Office products. Strong organizational skills with attention to detail. Ability to collaborate with coding staff, providers, billing teams, and revenue cycle leadership.
Outpatient Denials Coder (Mid Revenue Cycle Integrity Analyst) Location:
100% Remote Duration:
6 months with possible extension
Major Responsibilities Reviews and analyzes outpatient medical record documentation, coding, and billing data to identify root causes of coding‐related denials, underpayments, and reimbursement variances. Investigates payer denials by evaluating CPT/HCPCS codes, ICD-10-CM diagnoses, modifiers, NCCI edits, medical necessity requirements, and payer-specific coding/billing rules. Prepares accurate and timely appeals with supporting documentation to overturn inappropriate denials and recover reimbursement. Identifies trends in denials and collaborates with coding leadership, clinical departments, billing teams, and revenue cycle partners to address systemic issues and reduce future denials. Performs detailed audit and reconciliation of coded claims to ensure compliance with regulatory and payer guidelines, including Medicare, Medicaid, and commercial policies. Participates in process-improvement initiatives related to charge capture, documentation workflows, coding accuracy, and denial prevention. Develops and maintains documentation of denials workflows, appeal templates, root-cause analysis results, and process improvements. Monitors key performance indicators (KPIs) related to denial rates, appeal success rates, coder accuracy, and timely filing requirements. Assists in training or educating outpatient providers, coding staff, and operational teams on denial trends, coding accuracy, documentation needs, and payer policy updates. Works closely with revenue cycle teams to ensure timely submission, tracking, and resolution of claims and appeals. Supports the development and optimization of outpatient coding/denial workflows by helping translate operational needs into process improvements and ensuring accurate data tracking.
Licensure, Registration, and/or Certification Required Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Outpatient Coder (COC) required. Additional AHIMA or AAPC certifications preferred.
Education Required Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, Coding, or related field
Experience Required Typically requires
3+ years of outpatient coding experience , including CPT/HCPCS, ICD-10-CM, and modifier application. Experience reviewing, appealing, and resolving outpatient coding denials strongly preferred. Familiarity with payer policies, medical necessity standards, NCCI edits, and reimbursement methodologies (APCs, OPPS, etc.).
Knowledge, Skills & Abilities Required Strong working knowledge of outpatient coding guidelines, CMS policies, and commercial payer requirements. Experience interpreting denial codes, remittance advice (RAs/EOBs), and root-cause identification. Analytical skills required to evaluate denial trends and make data-driven recommendations for process improvement. Strong written communication skills for preparing clear, effective appeal letters. Ability to manage multiple cases, prioritize deadlines, and work independently in a remote environment. Intermediate computer skills, including use of EMRs, encoder tools, claim scrubbers, denial management systems, and Microsoft Office products. Strong organizational skills with attention to detail. Ability to collaborate with coding staff, providers, billing teams, and revenue cycle leadership.