Certified Denials Specialist

Job Summary

A company is looking for a Denials Specialist with coding expertise.

Key Responsibilities:

• Review documentation to ensure accuracy of diagnoses and procedure codes
• Research coding policies and payer guidelines to resolve claim denials
• Identify trends and provide feedback to prevent future denials

Required Qualifications:

• Professional coding certification (CPC, CCS, CIC, or COC) and 1 year of experience in a coding-related denials management role
• Experience with complex surgical specialties and interventional radiology is a plus
• Familiarity with Athena is preferred
• Experience with various denial types including medical necessity and incorrect modifier usage
• Strong knowledge of CPT, HCPCS, ICD-10-CM/PCS, modifiers, and Medicare billing rules