Coding Denials Specialist – Clinical Practice Services

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

📋 Description

• Conduct research on payer denials related to coding, documentation, referrals, pre-authorizations, notifications, medical necessity, non-covered services, and billing.

• Analyze claim denials, account/guarantor notes, and medical records to ascertain necessary actions.

• Assess whether revised claims, retro authorizations, written appeals, or no action are warranted.

• Compose and submit professionally crafted appeals based on clinical documentation, payer medical policies, and contract stipulations.

• Submit tailored appeals in compliance with Medicare, Medicaid, third-party guidelines, and MCW/CPS compliance regulations.

• Collaborate with the prior authorization team to secure retro-authorizations.

• Identify denial trends and escalate matters for follow-up or root cause analysis.

• Suggest modifications to work queues and claim edits to enhance efficiency and minimize denials.

• Review payer communications and pinpoint reimbursement risks associated with medical policies and prior authorization prerequisites.

• Escalate potential concerns to clinical stakeholders, managed care contracting, and Revenue Cycle leadership.

• Spot process improvement opportunities and engage in initiatives aimed at process enhancements.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• High school diploma.

• A minimum of five (5) years of experience in a healthcare environment, focusing on coding and/or reimbursement follow-up.

• Certified professional coder (CCS-P, CPC, or CCA) and/or health information management credential (RHIT or RHIA).

• Familiarity with payer policies and claims requirements.

• Advanced understanding of CPT, ICD-10 coding, as well as payer and governmental policies.

• Proficiency in EMRs (EPIC) and Microsoft Office applications.

• Strong communication skills alongside effective writing capabilities.

• Ability to handle multiple tasks efficiently and effectively.

• Excellent interpersonal skills, with a focus on fostering teamwork.

• Strong analytical and problem-solving abilities.

🏝️ Benefits

• Exceptional Healthcare Coverage, including Health, Vision, and Dental.

• Flexible Spending options available.

• 403B Retirement Package.

• Competitive Vacation and Paid Holidays provided.

• Tuition Reimbursement programs.

• Paid Parental Leave.

• Employee & Family Assistance Program (EFAP).

• Pet Insurance options.

• On-campus Fitness Facility, offering onsite classes.

• Discounted rates on select cell phone plans, local fitness centers, and Milwaukee recreation and entertainment.