Keck Medicine of USC
Senior Coding Denials Management Specialist (HIM Inpatient) - HIM Financial - Fu
Keck Medicine of USC, Los Angeles, California, United States, 90079
Senior Coding Denials Management Specialist (HIM Inpatient) – HIM Financial – Full Time 8 Hour Days (Non-Exempt) (Non-Union)
Join to apply for the
Senior Coding Denials Management Specialist (HIM Inpatient) – HIM Financial – Full Time 8 Hour Days (Non-Exempt) (Non-Union)
role at
Keck Medicine of USC .
In accordance with current federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist analyzes, investigates, mitigates, and resolves all coding-related “claims denials” and “claims rejections,” specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers—from Medicare, Medi-Cal, MAC, RAC, and commercial insurance companies—when there is refusal or rejection to honor Keck Medicine of USC request for payment for both IP & OP healthcare services provided to covered patients. The specialist manages the denial management process for coding-related denials, triages denied claims to distinguish coding-related denials versus clinical-related denials, evaluates claims deemed inappropriately paid by the payer/external auditors, and determines the need for appeal. Performs all 1st and 2nd level coding-related denial appeals. All tasks & duties must be performed in compliance with federal & state coding laws, rules, regulations, Official Coding Guidelines, AHA Coding Clinic, AMA CPT Assistance, NCCI, NCD, LCDs, etc. The specialist analyzes, investigates, and resolves coding-related pre-bill edits from the Patient Financial Services (PFS) Dept. Researches, responds, and documents findings, correspondence, and notes regarding coding-related “claims denials” and “claims rejections” on patient accounts in both the Coding & Billing systems. The role is responsible for reviewing reports/work queues to identify and correct the root cause for claim rejections and denials that might prevent or delay payment.
Prepares appeals and rebuttal letters/packages in response to payer's reasons for coding-related “claims denials” and “claims rejections,” including documentation and an argument, and follows up with the PFS regarding possible reimbursement. Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution. Develops reporting tools that measure and monitor processes throughout the denials management process to support process improvement. Initiates appropriate CDI query engagements with Coders & CDI Specialists to acquire necessary clinical documentation needed to facilitate accurate and complete coding, abstracting, and DRG assignments. Participates in responses to inquiries regarding coding and clinical documentation from Coders, CDI Specialists, and all other internal & external customers. Performs other HIM Coding Department duties as assigned by the HIM leadership team. Excellent written and oral communication skills, human relations and leadership skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts are required.
Essential Duties
CODING AUDITING – Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a 95% coding accuracy rate.
Develops monitoring/education plans for coding staff who do not meet the 95% accuracy rate.
Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
Acts as a resource to coding and hospital staff on coding issues and questions.
Ensures a 95% accuracy rate as determined by an annual external review of coding.
ABSTRACTING AUDITING – Performs monthly internal abstracting audits to evaluate accuracy of coding staff to ensure a 95% abstracting accuracy rate.
Develops monitoring/education plans for coding staff who do not meet the 95% abstracting rate.
Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
Acts as a resource to coding staff on difficult coding issues.
UNDER GENERAL SUPERVISION, RESPONSIBLE FOR – Provides guidance and training to other HIM Coding Denials Management Specialists.
Performs all 1st and 2nd level coding-related denial appeals.
Inpatient coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracts patient information as required by official coding laws.
Reviews the entire medical record, accurately classifies and sequences diagnoses and procedures, and ensures capture of all documented conditions that coexist at the time of the encounter.
Enters patient information into inpatient and outpatient medical record databases (ClinTrac/HDM) and ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements before billing interface and claims submission.
Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist to obtain documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.
Assists in the correction of regulatory reports, such as OSHPD, as requested.
Maintains attendance, punctuality, and professionalism in all HIM Coding and work related activities.
Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions.
Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.
CODING & ABSTRACTING ACCURACY – Achieves a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).
Achieves a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).
Assists in ensuring all medical records contain necessary information for optimal and accurate coding and abstracting.
Recognizes education needs based on monthly reviews and conducts self‑improvement activities.
CODING OPTIMIZATION – Improves MS-DRG assignments related to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
Improves APR-DRG, SOI, and ROM assignments related to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
Improves APC/HCC assignments based on medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.
TIMELINESS OF AUDITING/CODING & PRODUCTIVITY – Maintains expected productivity standards (see HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.
Ensures 95% of patient bills are dropped within 5 days after patient discharge/date of service.
Ensures remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.
Assists other coders in performance of duties including answering questions and providing guidance, as necessary.
Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and providing information to generate interim bill.
Assists in monitoring unbilled accounts to ensure oldest records are coded and/or given priority.
CONTINUING EDUCATION – Maintains AHIMA and/or AAPC coding credential(s) specified in the job description.
Attends coding & CDI seminars, webinars, and in‑services to maintain required annual CEU.
Keeps up‑to‑date reviews of ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, CPT Assistant, and other professional journals and newsletters for updated coding knowledge.
Consistently attends and actively participates in daily huddles.
POLICY & PROCEDURES; PERFORMANCE IMPROVEMENT – Consistently adheres to HIM policies and procedures as directed by HIM management.
Demonstrates understanding of policies and procedures and seeks clarification as needed.
Participates in continuous assessment and improvement of departmental performance.
Communicates changes to improve processes to the director, as needed.
Assists in department and section quality improvement activities and processes (e.g. Performance Improvement).
COMMUNICATION – Works and communicates in a positive manner with management and supervisory staff, medical staff, co‑workers and other healthcare personnel.
Communicates effectively intra‑departmentally, inter‑departmentally and with external customers.
Provides timely follow‑up with written and verbal requests for information, including voicemail and e‑mail.
Performs other duties as assigned.
SYSTEMS – Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage.
Working knowledge, efficient navigation and full use of 3M-CRS Encoder system; utilizes references to expedite coding process.
Knowledge and understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac.
Working knowledge, efficient navigation and full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software.
Working knowledge, efficient navigation and full use of ‘3M 360 Encompass/CAC’.
Required Qualifications
High School diploma or equivalent.
College courses in Medical Terminology, Anatomy & Physiology and a certified coding course; thorough knowledge of ICD/DRG coding and/or CPT/HCPCS coding principles, and AHIMA coding competencies.
10 years experience in ICD, CPT/HCPCS coding of inpatient & outpatient medical records in an acute care facility.
Experience using computerized coding & abstracting database software and encoding/code‑finder systems (e.g., 3M 360 Encompass/CAC & 3M Coding & Reimbursement System (CRS)).
Knowledge of CPT, HCPCs and ICD9 coding principles.
Strong organization/time management skills.
Excellent customer service behavior.
Excellent verbal and written communication skills.
Ability to function independently and as a member of a team.
Preferred Qualifications
1–2 years lead experience.
Required Licenses/Certifications
AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; or either the CCS or CIC in conjunction with any one of the following national HIM credentials: AHIMA Registered Health Information Technician (RHIT) or AHIMA Registered Health Information Administrator (RHIA). Successful completion of the hospital‑specific coding test with a passing score of ≥90%.
Fire Life Safety Training (LA City) – must obtain card within 30 days of hire and maintain by renewal before expiration date (required within LA City only).
The hourly rate range for this position is $46.00 - $76.07.
Job ID: REQ20168328 | Posted Date: 01/10/2026
Apply
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Senior Coding Denials Management Specialist (HIM Inpatient) – HIM Financial – Full Time 8 Hour Days (Non-Exempt) (Non-Union)
role at
Keck Medicine of USC .
In accordance with current federal & state coding compliance regulations and guidelines, the HIM Coding Denials Management Specialist analyzes, investigates, mitigates, and resolves all coding-related “claims denials” and “claims rejections,” specific to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers—from Medicare, Medi-Cal, MAC, RAC, and commercial insurance companies—when there is refusal or rejection to honor Keck Medicine of USC request for payment for both IP & OP healthcare services provided to covered patients. The specialist manages the denial management process for coding-related denials, triages denied claims to distinguish coding-related denials versus clinical-related denials, evaluates claims deemed inappropriately paid by the payer/external auditors, and determines the need for appeal. Performs all 1st and 2nd level coding-related denial appeals. All tasks & duties must be performed in compliance with federal & state coding laws, rules, regulations, Official Coding Guidelines, AHA Coding Clinic, AMA CPT Assistance, NCCI, NCD, LCDs, etc. The specialist analyzes, investigates, and resolves coding-related pre-bill edits from the Patient Financial Services (PFS) Dept. Researches, responds, and documents findings, correspondence, and notes regarding coding-related “claims denials” and “claims rejections” on patient accounts in both the Coding & Billing systems. The role is responsible for reviewing reports/work queues to identify and correct the root cause for claim rejections and denials that might prevent or delay payment.
Prepares appeals and rebuttal letters/packages in response to payer's reasons for coding-related “claims denials” and “claims rejections,” including documentation and an argument, and follows up with the PFS regarding possible reimbursement. Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution. Develops reporting tools that measure and monitor processes throughout the denials management process to support process improvement. Initiates appropriate CDI query engagements with Coders & CDI Specialists to acquire necessary clinical documentation needed to facilitate accurate and complete coding, abstracting, and DRG assignments. Participates in responses to inquiries regarding coding and clinical documentation from Coders, CDI Specialists, and all other internal & external customers. Performs other HIM Coding Department duties as assigned by the HIM leadership team. Excellent written and oral communication skills, human relations and leadership skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts are required.
Essential Duties
CODING AUDITING – Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a 95% coding accuracy rate.
Develops monitoring/education plans for coding staff who do not meet the 95% accuracy rate.
Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
Acts as a resource to coding and hospital staff on coding issues and questions.
Ensures a 95% accuracy rate as determined by an annual external review of coding.
ABSTRACTING AUDITING – Performs monthly internal abstracting audits to evaluate accuracy of coding staff to ensure a 95% abstracting accuracy rate.
Develops monitoring/education plans for coding staff who do not meet the 95% abstracting rate.
Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
Acts as a resource to coding staff on difficult coding issues.
UNDER GENERAL SUPERVISION, RESPONSIBLE FOR – Provides guidance and training to other HIM Coding Denials Management Specialists.
Performs all 1st and 2nd level coding-related denial appeals.
Inpatient coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracts patient information as required by official coding laws.
Reviews the entire medical record, accurately classifies and sequences diagnoses and procedures, and ensures capture of all documented conditions that coexist at the time of the encounter.
Enters patient information into inpatient and outpatient medical record databases (ClinTrac/HDM) and ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements before billing interface and claims submission.
Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist to obtain documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.
Assists in the correction of regulatory reports, such as OSHPD, as requested.
Maintains attendance, punctuality, and professionalism in all HIM Coding and work related activities.
Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions.
Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.
CODING & ABSTRACTING ACCURACY – Achieves a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).
Achieves a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).
Assists in ensuring all medical records contain necessary information for optimal and accurate coding and abstracting.
Recognizes education needs based on monthly reviews and conducts self‑improvement activities.
CODING OPTIMIZATION – Improves MS-DRG assignments related to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
Improves APR-DRG, SOI, and ROM assignments related to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
Improves APC/HCC assignments based on medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.
TIMELINESS OF AUDITING/CODING & PRODUCTIVITY – Maintains expected productivity standards (see HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.
Ensures 95% of patient bills are dropped within 5 days after patient discharge/date of service.
Ensures remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.
Assists other coders in performance of duties including answering questions and providing guidance, as necessary.
Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and providing information to generate interim bill.
Assists in monitoring unbilled accounts to ensure oldest records are coded and/or given priority.
CONTINUING EDUCATION – Maintains AHIMA and/or AAPC coding credential(s) specified in the job description.
Attends coding & CDI seminars, webinars, and in‑services to maintain required annual CEU.
Keeps up‑to‑date reviews of ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, CPT Assistant, and other professional journals and newsletters for updated coding knowledge.
Consistently attends and actively participates in daily huddles.
POLICY & PROCEDURES; PERFORMANCE IMPROVEMENT – Consistently adheres to HIM policies and procedures as directed by HIM management.
Demonstrates understanding of policies and procedures and seeks clarification as needed.
Participates in continuous assessment and improvement of departmental performance.
Communicates changes to improve processes to the director, as needed.
Assists in department and section quality improvement activities and processes (e.g. Performance Improvement).
COMMUNICATION – Works and communicates in a positive manner with management and supervisory staff, medical staff, co‑workers and other healthcare personnel.
Communicates effectively intra‑departmentally, inter‑departmentally and with external customers.
Provides timely follow‑up with written and verbal requests for information, including voicemail and e‑mail.
Performs other duties as assigned.
SYSTEMS – Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage.
Working knowledge, efficient navigation and full use of 3M-CRS Encoder system; utilizes references to expedite coding process.
Knowledge and understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac.
Working knowledge, efficient navigation and full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software.
Working knowledge, efficient navigation and full use of ‘3M 360 Encompass/CAC’.
Required Qualifications
High School diploma or equivalent.
College courses in Medical Terminology, Anatomy & Physiology and a certified coding course; thorough knowledge of ICD/DRG coding and/or CPT/HCPCS coding principles, and AHIMA coding competencies.
10 years experience in ICD, CPT/HCPCS coding of inpatient & outpatient medical records in an acute care facility.
Experience using computerized coding & abstracting database software and encoding/code‑finder systems (e.g., 3M 360 Encompass/CAC & 3M Coding & Reimbursement System (CRS)).
Knowledge of CPT, HCPCs and ICD9 coding principles.
Strong organization/time management skills.
Excellent customer service behavior.
Excellent verbal and written communication skills.
Ability to function independently and as a member of a team.
Preferred Qualifications
1–2 years lead experience.
Required Licenses/Certifications
AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; or either the CCS or CIC in conjunction with any one of the following national HIM credentials: AHIMA Registered Health Information Technician (RHIT) or AHIMA Registered Health Information Administrator (RHIA). Successful completion of the hospital‑specific coding test with a passing score of ≥90%.
Fire Life Safety Training (LA City) – must obtain card within 30 days of hire and maintain by renewal before expiration date (required within LA City only).
The hourly rate range for this position is $46.00 - $76.07.
Job ID: REQ20168328 | Posted Date: 01/10/2026
Apply
#J-18808-Ljbffr