Denial Coding Specialist - EM/ ED Speciality

Ventra Health; Chennai District; On-site; INR 360,000 - 520,000; Full time

Job summary

Ventra Health is seeking a denial management specialist in Chennai to process accounts, validate coding, and generate payor appeals. You will resolve prioritized queues, adhere to policies, and maintain high production and quality standards.

The role requires knowledge of health insurance coding, CMS guidelines, and proficiency in Excel and data tools. Strong communication, organization, and the ability to work independently are essential.

Qualifications

• Knowledge of health insurance and coding.
• Familiarity with physician billing policies and procedures.
• Understanding healthcare reimbursement guidelines.
• Knowledge of ICD-10-CM and CPT coding guidance (AHA/CMS).
• Proficient with Excel; able to use pivot tables.
• Ability to work in a fast-paced environment.
• Strong written and verbal communication, and organization.

Responsibilities

• Process accounts meeting denial management criteria, including rejections, down codes, modifiers, and level of service.
• Resolve work queues per priority and management direction, following policies.
• Validate denial reasons and ensure coding accuracy.
• Generate appeals based on dispute reasons and payor terms; include online reconsiderations.
• Follow payer guidelines for appeals submission and escalate exhausted efforts.
• Adhere to departmental production and quality standards.
• Complete special projects as assigned and maintain knowledge of workflows and tools.
• Communicate effectively and work collaboratively to achieve goals.

Skills

Healthcare billing knowledge

Coding knowledge (ICD-10-CM/CPT)

AHA guidelines familiarity

CMS policies familiarity

Excellent communication

Analytical skills

Organizational skills

Independent work ethic

Microsoft Excel proficiency

Outlook/Word basics

Tools

Excel

Pivot tables

Database software

Outlook

Word

Job description

Role & 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

Preferred candidate profile

• Knowledge of health insurance, including coding.
• Thorough knowledge of physician billing policies and procedures.
• Thorough knowledge of healthcare reimbursement guidelines.
• Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding.
• Computer literate, working knowledge of Excel helpful.
• Able to work in a fast-paced environment.
• Good organizational and analytical skills.
• Ability to work independently.
• Ability to communicate effectively and efficiently.
  Proficient computer skills, with the ability to learn applicable internal systems.
  Ability to work collaboratively with others toward the accomplishment of shared goals.
• Basic use of computer, telephone, internet, copier, fax, and scanner.
• Basic touch 10 key skills.
• Basic Math skills.
• Understand and comply with company policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong time management and organizational skills.
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.

Perks and benefits