Coding Denials Specialist

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

📋 Description

• Process accounts that meet the criteria for coding denial management, which includes rejections, down codes, bundling issues, modifiers, level of service, and other designated queues.

• Address work queues based on established priorities or management instructions, adhering to policies, procedures, and job aids.

• Examine health plan denials and identify appropriate actions and resolutions.

• Confirm denial reasons and ensure coding accuracy.

• Create appeals based on the reasons for disputes and payer-specific contract terms, including online reconsiderations.

• Adhere to payer guidelines for submitting appeals.

• Elevate exhausted appeal efforts for resolution.

• Achieve departmental production and quality benchmarks.

• Accomplish special projects as assigned by management.

• Maintain an up-to-date understanding of departmental workflows, systems, and tools.

⛳️ Requirements

• High school diploma or equivalent qualification.

• One to three years of experience in physician medical billing, with a focus on research and claims denials.

• Current certification from AAPC or AHIMA is required.

• Knowledge of health insurance and coding practices.

• Comprehensive understanding of physician billing policies and procedures.

• In-depth knowledge of healthcare reimbursement guidelines.

• Familiarity with AHA Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10-CM and CPT coding.

• Proficient computer skills and the ability to learn relevant internal systems.

• Working knowledge of Excel is advantageous.

• Capability to thrive in a fast-paced environment.

• Strong organizational and analytical abilities.

• Capacity to work both independently and collaboratively toward common objectives.

• Effective and efficient communication skills.

• Basic proficiency in using a computer, telephone, internet, copier, fax, and scanner.

• Fundamental touch 10-key skills.

• Basic mathematical skills.

• Ability to understand and adhere to company policies and procedures.

• Excellent oral, written, and interpersonal communication skills.

• Strong time management and organizational capabilities.

• Proficient knowledge of Outlook, Word, Excel (including pivot tables), and database software.

🏝️ Benefits

• Ventra performance-based incentive plan.

• Referral bonus for recommending a friend.

• Discretionary incentive bonus in line with company policies.

• Reasonable accommodations for qualified individuals with disabilities.