Coding Denials Specialist

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

📋 Description

• Manage and process designated claim edits and rejection work queues.

• Investigate and address health plan denials promptly.

• Handle rejections, down codes, bundling issues, modifiers, level-of-service discrepancies, and other assigned queues.

• Resolve work queues following established priorities, management guidance, policies, procedures, and job aids.

• Verify denial reasons and ensure coding accuracy.

• Prepare appeals based on dispute justifications and payer contract terms, including online reconsiderations.

• Adhere to payer-specific appeal submission protocols.

• Escalate unresolved appeal efforts for further resolution.

• Achieve departmental production and quality benchmarks.

• Undertake special projects as assigned by management.

• Maintain a solid 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 claim denials.

• Current AAPC or AHIMA certification is mandatory.

• Familiarity with health insurance and coding is essential.

• 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 in computer use and internal systems.

• Competent in Outlook, Word, Excel (including pivot tables), and database software.

• Ability to thrive in a fast-paced environment.

• Strong organizational and analytical abilities.

• Capacity to work both independently and as part of a team.

• Excellent oral, written, and interpersonal communication skills.

• Basic skills in computer operation, telephone, internet, copier, fax, and scanner usage.

• Fundamental touch 10-key skills.

• Basic mathematical skills.

• Ability to adhere to company policies and procedures.

• Strong time-management and organizational skills.

🏝️ Benefits

• Performance-driven incentive plan.

• Referral bonus for recommending a friend.

• Reasonable accommodations for qualified individuals with disabilities.