Coding Denials Specialist (EM IP Coding)

Ventra Health; Chennai District; On-site; INR 250,000 - 450,000; Full time

Job summary

Ventra Health is seeking a Coding Denial Specialist to handle assigned claim edits and denial work queues. You will investigate denials, validate reasons, and determine corrective actions to secure resolutions.

The role requires 1–3 years of physician medical billing experience with a focus on denials and a current AAPC or AHIMA certification. This on-site position demands accuracy and adherence to departmental standards.

Qualifications

• The candidate should have a high school diploma or equivalent.
• 1–3 years of physician medical billing experience with emphasis on denials.
• Current AAPC or AHIMA certification is required.

Responsibilities

• Process coding denial edits and rejections in assigned queues.
• Resolve denials by validating reasons and ensuring coding accuracy.
• Generate appeals based on payor dispute reasons and contract terms.
• Follow payer guidelines for submitting appeals online where applicable.
• Escalate unresolved appeals per management directions.
• Maintain adherence to departmental production and quality standards.
• Complete special projects as assigned and stay current with systems used.

Skills

Medical billing

Denials management

Research

Education

AAPC/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.