Denials Coder

Job Description: Denial Coder – Oncology (Outpatient)

Experience Required: Minimum 2 Years
Department: Medical Coding
Specialization: Oncology – Outpatient Coding and Denial Management

Job Summary

We are looking for an experienced Denial Coder – Oncology (Outpatient) with a minimum of 2 years of relevant experience in oncology coding, denial analysis, and medical billing. The candidate will be responsible for reviewing denied outpatient oncology claims, identifying coding-related issues, validating medical documentation, and ensuring accurate coding and timely resolution of denials in accordance with payer guidelines and applicable coding standards.

Key Responsibilities

• Review and analyze denied outpatient oncology claims to identify root causes of denials.
• Perform detailed medical record reviews to validate diagnoses, procedures, and services billed.
• Review and validate ICD-10-CM, CPT, and HCPCS codes applicable to outpatient oncology services.
• Identify coding discrepancies, medical necessity issues, authorization-related denials, and documentation gaps.
• Analyze denials related to chemotherapy, immunotherapy, radiation therapy, infusion services, and other outpatient oncology procedures.
• Verify appropriate coding of oncology diagnoses, treatment procedures, drug administration, and applicable modifiers.
• Determine appropriate corrective actions, including claim corrections, rebilling, and appeals, based on denial reasons.
• Prepare accurate and well-supported appeal documentation in coordination with billing and clinical teams.
• Ensure compliance with payer-specific guidelines, coding regulations, and applicable compliance requirements.
• Track denial trends, identify recurring issues, and recommend process improvements to reduce denial rates.
• Maintain productivity, quality, and turnaround-time targets as defined by the organization.

Required Skills and Qualifications

• Minimum 2 years of experience in medical coding in oncology outpatient coding and denial management.
• Strong knowledge of outpatient oncology coding, including ICD-10-CM, CPT, and HCPCS coding guidelines.
• Working knowledge of chemotherapy, immunotherapy, radiation therapy, infusion coding, and drug administration services.
• Experience in analyzing claim denials, identifying root causes, and supporting appeals or claim corrections.
• Understanding of medical necessity requirements, payer policies, authorization requirements, and documentation standards.
• Familiarity with US healthcare RCM processes and insurance payer guidelines.
• Strong analytical skills, attention to detail, and the ability to interpret clinical documentation.
• Good communication skills and the ability to coordinate with internal teams.

Preferred Qualifications

• Relevant medical coding certification such as CPC, CCS, or a specialty coding credential.
• Experience working with US healthcare clients and payer-specific denial workflows.
• Knowledge of oncology-specific coding updates and applicable reimbursement guidelines.

Pay: ₹40,000.00 - ₹75,000.00 per month

Benefits:

• Health insurance
• Provident Fund

Work Location: In person