Revenue Cycle Denials & Coding Analyst

Gravity Diagnostics•Covington, KY

About The Position

This role focuses on optimizing revenue 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 practices. You'll leverage strong analytical skills, data tools, and revenue cycle expertise to support compliance, reduce denials, and maximize reimbursement. This role is highly analytical and strategic but also requires hands on execution of projects and tasks as assigned.

Requirements

In-depth knowledge of CPT/HCPCS codes, payer policies, government guidelines, and regulatory compliance.
Exceptional analytical and problem-solving skills, with a track record of reducing denials and improving reimbursement.
Excellent communication skills to translate data into actionable strategies for denials, appeals, and coding.
Ability to work both independently and collaboratively, fast-paced lab revenue cycle team.
Bachelor’s degree in Business Administration, Finance, Data Analytics, Medical Technology, or related field; or equivalent experience.
Certified Professional Coder (CPC) is required.
8+ years of experience in revenue cycle management, with a focus on medical billing, coding, denials, and appeals in healthcare or lab environments.
Strong technical skills in Microsoft Office, SQL, PowerBI, and RCM software applications for data analysis and reporting.

Nice To Haves

Proven expertise in TELCOR Revenue Cycle Management system, including workflows for claims management, denial reduction, and operational processes, is preferred.
Experience in lab or provider settings, including multi-specialty or high-volume testing environments.

Responsibilities

Maintain the highest levels of compliance with all Gravity Diagnostics and applicable regulatory bodies policies, rules, laws, guidelines, and regulations.
Validate coding for current and new lab procedures to support accurate reimbursement.
Monitor and analyze payer 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 coding catalogue/ compendium.
Generate detailed reports on denial trends and identify patterns to reduce claim rejections in a high-volume lab setting.
Develop and implement claims denials strategies, including root cause analysis and proactive measures to minimize denials.
Support the appeals process by preparing documentation and analyzing submission success.
Leverage tools like SQL, PowerBI, Excel, and TELCOR reporting to aggregate complex data and build 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 contract and fee schedule loads.
Ensure claims submissions and reimbursements align with agreement terms.
Identify other trends in lab claims, denials, and payer activity, providing solutions to optimize revenue cycle efficiency.
Execute regular and ad hoc tasks/ projects as assigned.