Coding Denials & Edits Specialist, AAPC/AMHIMA Certification Required

This is a fully remote position, open to applicants in United States.

📋 Description

• Engage with insurance plans, patients, physicians, attorneys, and team members as required.

• Confirm or acquire patient eligibility and authorization for medical services.

• Update patient demographic details and insurance information in the relevant systems.

• Investigate and appropriately address unpaid or denied claims.

• Track claims for any missing information, authorizations, and control numbers (ICN/DCN).

• Analyze EOBs for payments or adjustments to resolve claims effectively.

• Communicate with payers via phone or written correspondence to secure claim payments.

• Access client systems for received payments, open claims, and other data necessary for claim resolution.

• Adhere to prioritization guidelines, timely filing deadlines, and documentation protocols.

• Acquire medical documentation requested by third-party insurance providers.

• Research provider billing manuals to obtain billing guidelines and requirements.

• Address denials and code edits appropriately.

• Draft appeal letters for technical appeals.

• Verify underpayment accuracy through contract and claims data analysis.

• Prepare claims for clinical audit processing in instances of authorization, coding, level-of-care, or length-of-stay denials.

• Ensure the prompt collection of outstanding government or commercial healthcare insurance receivables.

• Report to the Manager of Accounts Receivable Services.

⛳️ Requirements

• Minimum of 3 years of accounts receivable experience within the healthcare revenue cycle.

• Must possess an AAPC or AHIMA certification, such as CPC or RHIT.

• At least 2 years of experience with healthcare and/or insurance billing and processing.

• Experience with claims from professional physicians and hospital facilities.

• Ability to read and interpret an Explanation of Benefits (EOB).

• Knowledge of UB04 and HCFA 1500 forms.

• High School diploma required.

• Proficient in Outlook, Excel, and Word.

• Capable of managing email, Outlook calendar, and tasks effectively.

• Ability to perform basic arithmetic operations such as addition, subtraction, and multiplication.

• Skilled in communicating clearly and professionally.

• Strong interpersonal skills are essential.

• Ability to work independently with minimal supervision.

• Possess analytical and critical thinking abilities.

• Capable of performing computer-based tasks for 6–8 hours per day.

• Ability to lift and move materials weighing up to 20 lbs. occasionally.

🏝️ Benefits

• Opportunities for professional development and personal growth.

• Commitment to employee career advancement.