Coding Denials Specialist

Key Responsibilities:

• Process accounts meeting coding denial management criteria including rejections, down codes, bundling issues, modifiers, and level of service.
• Resolve work queues according to prescribed priority or management direction, validating denial reasons and ensuring accurate coding.
• Generate appeals based on dispute reason and contract terms specific to the payor, including online reconsiderations and following payer guidelines.

Qualifications:

• High school diploma or equivalent with one to three years experience in physician medical billing focusing on research and claim denials.
• Current AAPC or AHIMA certification required.
• Knowledge of health insurance, physician billing policies, healthcare reimbursement guidelines, and AHA/CMS directives.

Skills and Abilities:

• Proficient computer skills with ability to learn internal systems, including Excel, Outlook, Word, and database software.
• Strong organizational, analytical, time management, and communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.