Coding Denial and Resolution Specialist

Source API remote eligibility restrictions: United States Remote Work Approved States: Arizona Florida Georgia Idaho Iowa South Dakota Texas South Carolina Wisconsin North Carolina Michigan *If your state is not listed, you must relocate to Montana or one of the approved states above to be eligible for this position.Full-TimeMiddle

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Job Details

Experience: Three (3) years’ experience in advanced hospital and professional (practice) coding.
Required Skills: Microsoft ExcelMicrosoft OfficePowerPoint

Requirements

Associate’s Degree in Health Information Management, Business, or related field, or equivalent combination of education and experience may be considered.
Current coding certification: CCA, CPC, CCS, CCS-P, CPMA, RHIA, or RHIT.
Three (3) years’ experience in advanced hospital and professional (practice) coding.
Knowledge of ICD-10 diagnosis and procedure coding, CPT, HCPCS, modifiers, and coding guidelines.
Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills.
Bachelor’s Degree in Health Information Management, Business, or related field (Preferred).
Two (2) years’ experience in coding denial management, appeals, or related denial resolution work (Preferred).
Certified Professional Medical Auditor (CPMA) (Preferred).
Experience with Epic and 3M (Preferred).
Experience using payer portals, electronic work queues, and denial/appeals tracking tools (Preferred).

Responsibilities

Reviews and triages post-billed coding denials, rejections, and coding-related billing edits for assigned professional and/or facility claim inventory.
Validates denial rationale using remittance advice/Explanation of Benefits (EOB), payer policies, coding guidelines, and applicable regulations.
Performs medical record review to confirm documentation support, code selection, modifier usage, and charge accuracy; identifies and initiates required corrections.
Coordinates charge and coding corrections and supports rebilling actions in accordance with established workflows and department standards.
Drafts, submits, and tracks first-level and second-level appeals/reconsiderations, ensuring compliance with payer requirements and timely filing deadlines.
Documents actions taken, supporting evidence, communications, and outcomes in the denial management system to maintain a complete audit trail.
Analyzes denial trends and root-cause categories; prepares routine and ad hoc reports and communicates findings to stakeholders.
Partners with coding, billing, clinical staff, patient access, information systems, and compliance to resolve complex denials and implement denial prevention strategies.
Develops and delivers education and presentations to providers and staff on denial drivers and coding best practices, including National Correct Coding Initiative (NCCI) edits.
Maintains working knowledge of payer medical review policies and regulatory guidance, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

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