I have over 3 years of experience in outpatient coding, specifically focusing on denial management. My role involved reviewing denied claims, identifying the root causes such as coding errors or insufficient documentation, and resubmitting them with the necessary corrections. I am proficient in using coding software and have a strong understanding of ICD-10, CPT, and HCPCS coding systems, which has enabled me to effectively reduce denial rates and improve revenue cycle performance.

I regularly attend webinars and workshops hosted by reputable organizations like AHIMA and AAPC. Additionally, I subscribe to industry newsletters and participate in online forums where coding professionals discuss updates and challenges. This continuous learning approach ensures I am always aware of the latest coding guidelines, compliance requirements, and best practices to minimize denials and ensure accurate billing.

In one instance, a claim was denied due to a perceived lack of medical necessity. I reviewed the patient's medical records and identified that the documentation supported the procedure. I compiled a detailed appeal letter, including relevant clinical notes and coding references, and submitted it to the payer. The denial was overturned, resulting in full reimbursement. This experience highlighted the importance of thorough documentation review and effective communication with payers.

To prevent denials, I focus on accurate and detailed documentation review, ensuring all codes reflect the services provided and are supported by medical records. I also conduct regular audits and provide feedback to clinicians on documentation improvements. Additionally, I stay proactive by keeping abreast of payer-specific requirements and coding updates, which helps in submitting clean claims the first time.

I prioritize tasks based on the urgency and potential financial impact, using a systematic approach to manage my workload efficiently. I leverage coding software tools to streamline the review process and maintain open communication with team members to ensure collaborative problem-solving. This method allows me to meet tight deadlines without compromising the quality of my work, ensuring timely resolution of denials.