Coding Denial Specialist - Rev Cycle (Finance)

Position Summary:

RESTRICTED TO MMS/REVENUE CYCLE/CHARGE CAPTURE & CODING

The Coding Denial Specialist is responsible for resolving denied claims within the Charge Capture/Coding department under the direction of the Manager, Charge Capture & Coding and the Director, Charge Capture & Coding. The Denial Specialist collaborates with members of the Revenue Cycle Management (RCM) team including Clinical Documentation Improvement (CDI) to identify trends and develop rejection prevention strategies. This position is responsible for providing feedback using reports and data to coding managers. The Coding Denial Specialist applies official coding guidelines, payer policies and established departmental policies and procedures to resolve claim rejections ensuring that timely filing deadlines have not been exceeded.

UTHealth is looking for a detail-oriented and experienced Coding Denial Specialist to join our Revenue Cycle team. The ideal candidate will have a strong background in medical coding and billing, with a focus on identifying and resolving coding-related denials. This role involves analyzing denied claims, determining the root causes, and implementing corrective actions to ensure accurate and timely reimbursement. The specialist will work closely with healthcare providers and billing staff to educate them on coding guidelines and best practices. Excellent communication and problem-solving skills are essential, as the role requires effective collaboration to minimize future denials and optimize revenue cycle performance. If you are passionate about improving coding accuracy and have a keen eye for detail, we encourage you to apply and become a vital part of our team.

• Department: Revenue Cycle
• Status: Full-time
• Location: Remote (2 -4 weeks onsite for training @ 1851 Crosspoint Ave, 77054) meetings, additional training, etc.).
• Must live in Texas (TX) This is a Remote position, and you must reside in Texas
• Must be able to attend any required onsite meetings

**We DO NOT provide lodging or mileage reimbursement for training**

Position Key Accountabilities:

1. Performs timely and accurate review of coding related denials, appeal and submission, including tracking findings. Addresses denied claims and performs research to resolve coding related rejections. Reviews medical record and coded information to determine if coding needs to be changed or if an appeal is needed for resolution. Monitors and tracks denial trends to help identify education/feedback opportunities. Proactively monitors Revenue Cycle communications and payer websites for policy and guideline changes.
2. Responsible for reviewing underpayments in Rev Builder and resolving Claim Edits. Reviews charge sessions that require resolution via claim system edits in IDX and EPIC. Resolves edits per coding guidelines and department procedures. Performs reviews to validate missed coding opportunities and participates in meeting to review findings and provide feedback to coding leadership for coding education opportunities.
3. Performs other Coding functions as appropriate, including assisting with coding backlogs as necessary.
4. Adheres to established productivity standards and maintains tracking tools. Stays up-to-date with all federal, state and departmental coding guidelines and procedures. Attends department meetings to discuss denial trends and prevention opportunities.
5. Performs other duties as assigned.

Certification/Skills:

Must have one of the following certifications:
Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), or Certified Professional Coder (CPC). Knowledge of ICD-10 CM and CPT coding conventions. Proficiency in Microsoft Office suite, the ability to abstract data and maintain a database required
Effective verbal and written communication between internal and external customers
Excellent time management skills. Ability to work collaboratively in a remote environment.

Minimum Education:

High School Diploma or equivalent. Associates degree in Health Information Management or related healthcare field is preferred.

Minimum Experience:

3 years of experience in a Health Information Management (HIM) multi-specialty coding. Strong professional (pro-fee) coding experience in multi-specialty clinic, EPIC/IDX and Cerner EMR experience is preferred.
May substitute required experience with equivalent years of education beyond the minimum education requirement.

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.