Certified Coding Denials Specialist

Job Summary

Working remotely in a full-time capacity, the Certified Coding Denials Specialist will manage claim edits and rejection work queues, ensuring timely investigation and resolution of health plan denials while adhering to departmental standards.

Key responsibilities

• Process accounts that meet coding denial management criteria, including rejections and bundling issues
• Generate appeals based on dispute reasons and payer guidelines while escalating exhausted appeal efforts
• Adhere to departmental production and quality standards while completing special projects as assigned

Required qualifications

• High school diploma or equivalent
• One to three years of experience in physician medical billing with a focus on research and claim denials
• Current AAPC or AHIMA certification required
• Thorough knowledge of healthcare reimbursement guidelines and physician billing policies
• Proficient in Microsoft Excel and other relevant software applications