Denials and Appeals Analyst

The Denials and Appeals Analyst provides appeal and resolution of coding and billing related payor claim denials for hospital-based services.

Manages the denial and appeal process cycle (includes all necessary appeal activities including intake, processing, researching, writing, tracking, educating, etc.).

Maintain current knowledge of coding, compliance, and documentation guidelines and specifically proficiency in hospital coding systems: ICD (International Classification of Diseases), CPT (AMA Procedural Coding) and HCPCS Level II (Healthcare Common Procedural Coding).

Research authoritative resources to ensure compliance with documentation requirements necessary to support hospital charging practices.

Develop and maintains professional relationships with both external and internal customers (i.e., payors, associates, Clinicians, Directors, and Physicians).

Provide practical, appropriate, and cost-effective recommendations to management relating to process improvement and audit findings implications.

Consistently document relevant facts and information to support the work performed and the resulting conclusions using spreadsheets and audit findings.

Prioritize and organize multiple concurrent open audits while still providing quality customer service to financial and clinical departments.

Understand financial, operational, and compliance risks of processes when making corrective recommendations.



* High School Diploma required; Bachelor Degree is preferred.


* CPC Certification or Certified Outpatient Coding (COC) is required.


* Certification in hospital billing from a recognized national program (i.e., AHIMA, AAHAM, etc.).

is preferred.


* Certified Professional Medical Auditor (CPMA) is preferred.


* Minimum five years of hospital procedure coding experience is required.


* Claim auditing experience is preferred.

Clinical experience is preferred.