Revenue Cycle Denials & Coding Analyst

Covington, OH - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Revenue Cycle Denials & CodingAnalyst

Department:Revenue Cycle Management
Reports To: VP of Revenue Operations & Market Access
Pay Group: Exempt

This role focuses onoptimizingrevenue cycle performance in a high-volume lab environment through in-depth analysis of denial trends development of denial reduction strategies effective appeals management and alignment with payer policies and coding analytical skills data tools and revenue cycleexpertiseto support compliance reduce denials and maximize role is highly analytical andstrategic butalso requireshands onexecution of projects and tasks as assigned.

WhatYoullDo:

Maintainthe highest levels ofcompliance withallGravity Diagnostics and applicableregulatory bodiespolicies rules laws guidelines and regulations.
Validatecoding forcurrent andnew lab procedures to supportaccuratereimbursement.
Monitor and analyzepayer requirements coding changes and government guidelines to ensure ongoing accuracy of all claims coding configurations.
Thoroughly document all coding decisions into formalized SOPs and the RCM codingcatalogue/ compendium.
Generate detailed reports on denial trends andidentifypatterns to reduce claim rejections in a high-volume lab setting.
Develop and implement claimsdenialsstrategies including root cause analysis and proactive measures to minimize denials.
Support theappeals processbypreparing documentation andanalyzingsubmissionsuccess.
Leverage tools like SQLPowerBI Excel and TELCOR reporting toaggregate complex data andbuild actionable insights on denials appeals and payer performance.
Track KPIs related to denial rates appeal success and reimbursement timelines delivering data-driven recommendations.
Collaborate with RCM finance and lab operations teams to apply analytics for improved financial performance in claims and denials.
Support payer contractand fee schedule claims submissions and reimbursements align with agreement terms.
Identifyothertrends in lab claims denials and payer activity providing solutions tooptimizerevenue cycle efficiency.
Executeregular andad hoc tasks/ projectsas assigned.

What You Bring :

In-depth knowledge of CPT/HCPCS codes payer policies government guidelines and regulatory compliance.
Exceptional analytical and problem-solving skills witha track recordof reducing denials and improving reimbursement.
Excellent communication skills to translate data into actionable strategies fordenials appeals and coding.
Ability to workbothindependentlyandcollaboratively fast-paced lab revenue cycle team.

Qualifications:

Bachelors degree in Business Administration Finance Data Analytics Medical Technology or related field; or equivalent experience.
Certified Professional Coder (CPC)isrequired.
8 years of experience in revenue cycle management with a focus on medical billing coding denials and appeals in healthcare or lab environments.
Provenexpertisein TELCOR Revenue Cycle Management system including workflows for claims management denial reduction and operationalprocessesis preferred.
Strong technical skills in Microsoft Office SQLPowerBI and RCM softwareapplicationsfor data analysis and reporting.
Experience in lab or provider settings including multi-specialty or high-volume testing environments.

Physical Requirements:

Extended periods of sitting and computer use
Extended periods of talking listening and typing while on a phone

Gravity Diagnostics is an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race color religion national origin ancestry alienage or citizenship status age sex gender gender identity gender expression sexual orientation marital status disability military service and veteran status pregnancy childbirth and related medical conditions or any other characteristic protected by applicable federal state or local laws.
At Gravity Diagnostics information security is a shared responsibility. All employees and contractors are expected to comply with established cybersecurity policies and procedures including maintaining secure passwords protecting confidential data (including PHI) and completing mandatory training. Employees must remain vigilant against phishing and social engineering tactics and promptly report any suspicious activity or potential breaches to the IT Security Team.
Gravity Diagnostics will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business.

Required Experience:

Revenue Cycle Denials & CodingAnalystDepartment:Revenue Cycle ManagementReports To: VP of Revenue Operations & Market AccessPay Group: ExemptThis role focuses onoptimizingrevenue cycle performance in a high-volume lab environment through in-depth analysis of denial trends development of denial reduc...

Maintainthe highest levels ofcompliance withallGravity Diagnostics and applicableregulatory bodiespolicies rules laws guidelines and regulations.
Validatecoding forcurrent andnew lab procedures to supportaccuratereimbursement.
Monitor and analyzepayer requirements coding changes and government guidelines to ensure ongoing accuracy of all claims coding configurations.
Thoroughly document all coding decisions into formalized SOPs and the RCM codingcatalogue/ compendium.
Generate detailed reports on denial trends andidentifypatterns to reduce claim rejections in a high-volume lab setting.
Develop and implement claimsdenialsstrategies including root cause analysis and proactive measures to minimize denials.
Support theappeals processbypreparing documentation andanalyzingsubmissionsuccess.
Leverage tools like SQLPowerBI Excel and TELCOR reporting toaggregate complex data andbuild actionable insights on denials appeals and payer performance.
Track KPIs related to denial rates appeal success and reimbursement timelines delivering data-driven recommendations.
Collaborate with RCM finance and lab operations teams to apply analytics for improved financial performance in claims and denials.
Support payer contractand fee schedule claims submissions and reimbursements align with agreement terms.
Identifyothertrends in lab claims denials and payer activity providing solutions tooptimizerevenue cycle efficiency.
Executeregular andad hoc tasks/ projectsas assigned.

What You Bring :

In-depth knowledge of CPT/HCPCS codes payer policies government guidelines and regulatory compliance.
Exceptional analytical and problem-solving skills witha track recordof reducing denials and improving reimbursement.
Excellent communication skills to translate data into actionable strategies fordenials appeals and coding.
Ability to workbothindependentlyandcollaboratively fast-paced lab revenue cycle team.

Qualifications:

Bachelors degree in Business Administration Finance Data Analytics Medical Technology or related field; or equivalent experience.
Certified Professional Coder (CPC)isrequired.
8 years of experience in revenue cycle management with a focus on medical billing coding denials and appeals in healthcare or lab environments.
Provenexpertisein TELCOR Revenue Cycle Management system including workflows for claims management denial reduction and operationalprocessesis preferred.
Strong technical skills in Microsoft Office SQLPowerBI and RCM softwareapplicationsfor data analysis and reporting.
Experience in lab or provider settings including multi-specialty or high-volume testing environments.

Physical Requirements: