Denial Management Coder
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Job Description:
- Must be a certified professional coder – AAPC/ AHIMA
- Minimum of 2-3 years’ experience in Denial management, exposure of handling multi-specialty denials
- Immediate joiner on less notice period candidates preferred
Key Responsibilities:
- Analyse coding-related denials and perform detailed root cause analysis (RCA).
- Validate ICD-10-CM, CPT/HCPCS, E/M levels, modifiers, bundling, diagnosis sequencing, and medical necessity-related coding.
- Compare denied claims against clinical documentation and applicable coding guidelines.
- Determine whether claims require coding correction, reconsideration, or appeal support.
- Review applicable NCCI edits and payer-specific coding requirements.
- Identify recurring denial trends and recommend corrective and preventive actions (CAPA).
- Provide coding feedback and education based on denial findings.
- Maintain accurate denial documentation while meeting quality and TAT requirements.
- Check the accompanying Remarks codes [RARC] & EOB [Denial codes]
Qualifications:
- Experience in Medical Coding, Denial Management, Claims Review
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, E/M, and NCCI edits.
- Strong denial RCA, analytical, and problem-solving skills.
- CPC, CCS, CCS-P, COC or equivalent preferred
- Education Qualification: Life science graduate [Not pursuing post graduate]
Designation:
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