Coding Denials Resolution Specialist

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

📋 Description

• Accountable for evaluating all post-billed denials (including those related to coding) for accuracy and appealing them based on coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations.

• Functions as a member of a team of coding denials resolution specialists tasked with identifying and analyzing the root causes of denials.

• Responsible for utilizing coding knowledge and established procedures to monitor appeals through first, second, and additional levels, ensuring that appeals are filed promptly as required by payers.

• Enhances departmental awareness of coding best practices.

⛳️ Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or a related field, along with a minimum of four (4) years of experience in a hospital or clinic setting, health insurance company, managed care organization, or other healthcare financial service environments, engaging in medical claims processing, financial counseling, financial clearance, accounting, or customer service roles; or an equivalent combination of education and experience.

• Experience in a complex, multi-site environment is preferred.

• Must possess extensive knowledge of professional/physician diagnostic and procedural coding, typically acquired through a coding certificate program, and at least one (1) year of physician/professional and hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience, including DRG assignment.

• Must hold one of the following certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC). Certified Professional Medical Auditor (CPMA) will also be considered.

• Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.

• Possesses a detailed understanding of principles, methods, and techniques related to compliant healthcare billing and collections.

• Demonstrates proficiency in medical terminology, disease processes, patient health record content, and the medical record coding process.

• Must be comfortable working in a collaborative, shared leadership environment. Previous experience collaborating with Global Partner vendors is preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuous learning.

• Supportive work environment fostering teamwork and collaboration.