Coding Denials Specialist

Ventra Health, Inc.; Chennai; On-site; INR 400,000 - 650,000; Full time

Job summary

Ventra Health, Inc. seeks a Coding Denial Specialist to manage health plan denials and coding denial inquiries.

You will investigate, validate, and resolve denials, generate appeals, and follow payer guidelines to achieve timely resolutions. The role requires 1–3 years of physician medical billing experience with denials and current AAPC or AHIMA certification, in a collaborative, deadline-driven environment.

Qualifications

• High school diploma or equivalent.
• 1–3 years of physician medical billing experience with denials.
• Current AAPC or AHIMA certification required.

Responsibilities

• Process denial management tasks including rejections, down codes, modifiers, and level of service.
• Resolve work queues according to priority and management direction.
• Validate denial reasons and ensure coding accuracy.
• Generate appeals per payor disputes and contract terms; perform online reconsiderations.
• Follow payer guidelines for appeals submission.
• Escalate exhausted appeal efforts for resolution.
• Maintain production and quality standards; complete special projects.
• Maintain knowledge of workflow, systems and tools in the department.

Education

High school diploma or equivalent

Job description

Overview

• The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution.

Responsibilities

• Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques.
• Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides.
• Validate denial reasons and ensures coding is accurate.
• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
• Follow specific payer guidelines for appeals submission.
• Escalate exhausted appeal efforts for resolution.
• Adhere to departmental production and quality standards.
• Complete special projects as assigned by management.
• Maintain working knowledge of workflow, systems, and tools used in the department.

Qualifications

• High school diploma or equivalent.
• One to three years’ experience in physician medical billing with emphasis on research and claim denials.
• Current AAPC or AHIMA certification required.