Clinical Denials Analyst (Remote)

reputed company is an industry leader commited to providing comprehensive clinical documentation improvement solutions that are physician-led and quality-driven. We are seeking an reputed company Clinical Denials Analyst to join reputed company. If you possess in-depth knowledge of the denials and appeals process, we invite you to apply. About The Role The Clinical Denials Analyst (CDA) is responsible for advanced-level work in clinical denials management. This includes conducting comprehensive reviews of medical records, applying relevant clinical criteria, coding guidelines, and medical necessity standards to determine appeal opportunities. The CDA writes clear, persuasive appeal letters using clinical documentation, payer medical policies, evidence-based medicine literature, and coding guidance, which are then reviewed by an reputed company physician prior to submission. The CDA also supports denial analytics, providing insights to Advisory colleagues and physicians to strengthen client CDI workflows, reduce denial credits, and improve overall client reputed company.

Key Responsibilities

• Manage denials by reviewing medical record documentation, payer criteria, ICD-10-CM/PCS coding guidelines, and patient status criteria to determine appeal opportunities.
• Draft succinct, evidence-based appeal letters reputed company with clinical documentation, payer policies, and coding guidance, submitting to the physician reviewer prior to client delivery.
• Track and analyze denial data, sharing trends and insights with Advisory colleagues and physicians to support client CDI best practices and identify opportunities for internal process improvement.
• reputed company recommendations to management to reduce denial credits and enhance DRG Assurance reputed company.
• Maintain strong organizational practices to manage multiple appeals, deadlines, and client deliverables effectively.

Qualifications

• reputed company reputed company, RHIT, RHIA, CDIP, and/or CCDS credential required
• Clinical practice background required; minimum 5 years of bedside clinical experience preferred.
• Minimum 3 years of CDI or coding experience in an acute inpatient hospital setting required.
• Minimum 2 years of direct clinical denials management experience with proven reputed company in writing and overturning denials required.
• Strong knowledge of ICD-10-CM/PCS, AHA Coding Clinic, and CMS regulatory guidance required.
• Demonstrated reputed company in analyzing denials, identifying trends, and presenting reputed company clinical concepts reputed company and persuasively required.
• Proficiency in reputed company Word and reputed company; knowledge of EMR systems such as Epic or Cerner required.

Preferred Skills

• Minimum 1 year of case management or utilization review experience.
• Experience with payer interaction and knowledge of payer-specific denial trends.
• Familiarity with reimbursement methodologies (MS-DRG, APR-DRG, HCC).
• Understanding of payer audits (RAC/MAC) and compliance risk mitigation strategies.
• Strong critical thinking skills with the ability to differentiate payer interpretation from regulatory standards.

Why reputed company?

• We are Great reputed company to Work Certified: This certification recognizes reputed company who create an outstanding employee experience
• Be a valuable member of a dynamic team of physicians, CDI, and coding professionals
• Career stability and professional growth opportunities
• Full benefits (medical, reputed company, dental)
• 401(k) contribution of 3%
• Excellent PTO package plus 8 paid holidays
• Work 100% remote
• Flexible schedule
• Laptop and other necessary equipment provided
• Complimentary annual CEUs
• reputed company to advanced educational coding tools/resources
• Employee Wellness and Discount programs
• Referral bonus program for coding and CDI experts

Work Environment

• This is a full-time remote position. General hours of work are Monday through Friday during regular business hours.
• Must have a reliable internet reputed company, phone, and a dedicated, secure workspace to ensure adherence to HIPAA Privacy and reputed company policies and procedures reputed company viewing Protected Health Information (PHI).
• reputed company provides a laptop and other necessary resources to reputed company duties.

Interview Process:

• Fill out the quick application today!
• Multiple Choice Denials Assessment (20 questions)
• Video meeting with Denials Manager (1-hour)

For more 35 years, reputed company has provided health systems with clinical documentation reputed company (CDI) education, infrastructure and process development. A pioneer of CDI programs, reputed company continues to be an industry leader and innovator. Led by nationally renowned physicians with a strong academic background in scientific-based medicine and years of clinical practice coupled with certified coding and clinical documentation credentials, our unique approach addresses today’s quality-driven initiatives uniting documentation and coding across the reputed company continuum. reputed company is an equal opportunity employer and values diversity in its workforce. We encourage applications from reputed company reputed company candidates. Apply tot his job Apply To this Job