Coding Denials Specialist (EM IP Coding)

Ventra Health, Inc.; Chennai; On-site; INR 300,000 - 540,000; Full time

Job summary

Ventra Health, Inc. in Chennai, India, seeks a Coding Denial Specialist who handles claim denials and related edits with accuracy and urgency. This role focuses on researching and resolving denials within physician billing workflows.

The position requires 1–3 years of physician medical billing experience, a current AAPC or AHIMA certification, and the ability to generate appeals per payor guidelines. You will maintain quality standards and manage denial queues efficiently.

Qualifications

• High school diploma or equivalent.
• 1–3 years’ experience in physician medical billing with emphasis on research and claim denials.
• Current AAPC or AHIMA certification required.

Responsibilities

• Processes accounts that meet coding denial management criteria including rejections, down codes, bundling issues, modifiers, level of service and other assigned queues.
• Resolve work queues according to priority and management direction according to policies and procedures.
• Validate denial reasons and ensure coding is accurate.
• Generate an appeal based on the dispute reason and contract terms specific to the payor, including online reconsiderations.
• Follow 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.

Skills

Denial management

Physician billing

Claim research

Education

High school diploma or equivalent

AAPC or AHIMA certification

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.