Dec 05, 2024

Coding Denials Specialist - Contract

Contract (CPC) Certified Professional Coder

Job Description

Coding Denial Specialist is responsible for investigating and resolving third-party insurance coding denials and edits.  The Coding Denial Specialist also assist in optimizing reimbursement by thoroughly researching and taking the appropriate action to resolve all coding denials in a timely manner.

  • Reviews and research coding denials that have been received as no payment/previous submitted claims with a denied or no response for payors and service areas
  • Identifies root cause of the coding denial, resubmit claim and address/report the denial issue tothe the supervisor
  • Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews
  • Obtains and reviews medical records through EMR, site request or hospital portals for reconsideration purposes
  • Utilizes all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal denied claims
  • Effectively utilizes ICD 10 CM and CPT codes and related material to investigate and ensure that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
  • Organizes work/resources to accomplish objectives and meet timely filing deadlines
  • Demonstrates problem-solving skills related to coding denial analysis
  • Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively, to obtain necessary information to address denial issues
  • Meets productivity requirements to ensure excellent service is provided to customers
  • Adheres to compliance and corporate and departmental policies and procedures
  • Identifies all coding denial trends and provide education of steps to prevent future avoidable denials

Required Experience Level

Intermediate Level

Minimum Education

High School

Minimum Experience Required

2-4 years

Applicant Location

US residents only