Team Lead - Denial Management

Team Leader Denial Coding (Minimum 4+ years of relevant Denial Coding experience and 8+ years of overall healthcare/medical coding experience)

Overview:

A Team Leader Denial Management is responsible for leading denial coding operations, ensuring accurate claim review, effective denial resolution, and compliance with coding and payer guidelines. The role provides coding guidance, monitors team performance and quality, identifies denial trends, and drives corrective actions to reduce recurring denials.

Key Responsibilities

Lead and perform denial claim audits to validate coding accuracy, documentation support, payer compliance, and appropriate claim resolution.

Perform Root Cause Analysis (RCA) on denial trends and recommend effective corrective and preventive actions.

Identify and differentiate coding-related, documentation-related, billing-related, and non-coding denial issues and direct the appropriate teams for resolution.

Provide coding-based guidance and clear directives to the AR team on the appropriate handling of coding-related denials, including coding corrections, rebilling, resubmissions, and appeals.

Collaborate with coders, AR, billing, operations, providers, and other stakeholders to resolve complex or recurring denial issues.

Review payer responses, EOBs, denial codes, and supporting documentation to determine the appropriate coding and appeal strategy.

Provide timely and actionable feedback to coders on error charts and identify recurring knowledge gaps requiring focused training.

Conduct denial trend-based training and education sessions for coding teams to address recurring errors and improve coding accuracy.

Share provider- and facility-specific denial trends, coding gaps, and educational recommendations with Managers and relevant stakeholders.

Support the appeals process by providing coding audit findings, clinical/coding rationale, documentation requirements, and compliance evidence.

Maintain accurate denial logs, including denial category, root cause, recommended action, resolution status, and corrective action.

Monitor denial trends and identify opportunities to strengthen preventive coding workflows and controls.

Recommend workflow and system enhancements, including modifier validation prompts, coding compliance checks, and other denial-prevention controls.

Conduct quality checks and compliance reviews to ensure adherence to payer guidelines, organizational policies, coding standards, and established quality benchmarks.

Generate and present denial audit and trend reports, including denial percentages, error categories, root causes, resolution timelines, and and corrective action closure.

Ensure identified denial issues are followed through to resolution and that recurring issues are escalated appropriately and corrective action closure.

Support the Team/Management in establishing and monitoring denial coding KPIs, quality targets, training effectiveness, Qualifications & Experience

Must hold CPC (AAPC), CCS (AHIMA), or an equivalent recognized medical coding certification.

Minimum 4+ years of relevant Denial Coding experience and 8+ years of overall healthcare/medical coding experience.

Strong expertise in denial coding, denial analysis, and appeals, with the ability to distinguish between coding-related and non-coding-related denials.

Temporary Work-from-Home option may be available; candidates must be willing to report to the office based on client or business requirements.

Strong proficiency in medical record review, clinical documentation interpretation, and coding validation.

Experience in ED Facility, Observation, Ancillary, Radiology, IVR, IP/DRG, Multispecialty, Cardiology, and General Surgery coding is an added advantage.

Bachelors degree in Life Sciences, Nursing, Pharmacy, Physiotherapy, or a related medical/paramedical field.

Advanced degree/diploma in Hospital Administration or Healthcare Management is preferred.

Strong knowledge of Anatomy, Physiology, Pathophysiology, and Medical Terminology.

Strong analytical, problem-solving, communication, presentation, and reporting skills.

Proficiency in EMR/EHR systems, coding platforms, audit tools, and Microsoft Office/analytical reporting tools.

Prior experience in RCM, healthcare provider, hospital, or payer auditing is preferred.