Coding Denial Analyst Jobs in Nebraska (NOW HIRING)

GENERAL SUMMARY: 

Reviews and analyzes clinical documentation to independently assign accurate diagnosis and procedure codes that support compliant billing and optimal reimbursement. Applies comprehensive knowledge of coding standards across outpatient, clinic, emergency department, surgery, observation, and Professional Fee coding for Inpatient accounts. Ensures coding integrity through regulatory compliance, audit participation, provider collaboration, and adherence to quality and productivity standards. 

PRINCIPAL JOB FUNCTIONS: 

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.   

1. *Reviews and analyzes clinical documentation to accurately assign diagnosis and procedure codes in accordance with coding guidelines, payer requirements, and regulatory standards. 

1. *Assigns and sequences ICD-10-CM, CPT, and HCPCS codes and enters coded information to support accurate billing and timely reimbursement. 

1. *Applies coding expertise, medical necessity requirements, reimbursement methodologies, and compliance standards to complex outpatient, clinic, emergency department, surgery, observation, and professional services encounters. 

1. *Queries providers to obtain clarification of incomplete, conflicting, or unclear documentation and promotes accurate clinical documentation practices. 

1. *Investigates and resolves coding edits, claim denials, and reimbursement issues to support compliant claim processing and revenue cycle performance. 

1. *Participates in coding audits, peer reviews, quality assurance initiatives, and compliance activities to ensure coding accuracy and consistency. 

1. *Provides coding and documentation guidance to providers, staff, and operational teams and serves as a resource on coding, reimbursement, and regulatory requirements. 

1. *Identifies coding, documentation, denial, and reimbursement trends and contributes to process improvement efforts that enhance quality, compliance, and financial outcomes. 

1. Maintains professional coding competency through continuing education, ongoing development, and adherence to ethical and regulatory standards. 

1. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise. 

1. Participates in meetings, committees and department projects as assigned. 

1. Performs other related projects and duties as assigned.  

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed. 

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES: 

1. Knowledge of ICD-10-CM, CPT, and HCPCS coding principles and guidelines. 

1. Knowledge of medical terminology, anatomy, physiology, and disease processes relevant to code assignment 

1. Knowledge of computer hardware equipment and software applications relevant to work functions.  

1. Ability to meet accuracy, productivity, and turnaround standards using electronic health record and billing systems.  

1. Ability to review and analyze clinical documentation to determine appropriate diagnosis and procedure code assignment. 

1. Ability to apply coding guidelines, payer policies, and regulatory requirements accurately and consistently. 

1. Ability to communicate effectively both verbally and in writing. 

1. Ability to perform crucial conversations with desired outcomes.  

1. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff. 

1. Ability to problem solve and engage independent critical thinking skills. 

1. Ability to maintain confidentiality relevant to sensitive information. 

1. Ability to prioritize work demands and work with minimal supervision. 

1. Ability to maintain regular and punctual attendance. 

EDUCATION AND EXPERIENCE: 

High school diploma or equivalent required. Completion of formal coursework in ICD10CM, CPT and medical coding principles from an accredited or approved program required.  

One (1) year of facility or professional medical coding experience, including outpatient and clinic services.  

Demonstrated proficiency with ICD10CM, CPT, and HCPCS coding; working knowledge of anatomy, physiology, medical terminology, medical necessity rules, and electronic health record and billing systems. 

OTHER CREDENTIALS / CERTIFICATIONS: 

One (1) of the following required: 

• Certified Professional Coder (CPC) 

• Certified Professional Coder, Apprentice (CPC – A) 

• Certified Coding Specialist (CCS) 

• Certified Coding Specialist – PhysicianBased (CCSP) 

• Certified Coding Associate (CCA) 

• Certified Medical Coder (CMC) or CPTP (physician network–specific) 

• Registered Health Information Technician (RHIT) 

• Registered Health Information Administrator (RHIA) 

Candidates with five (5) or more years of directly related medical coding experience in lieu of a required credential may be considered.