Requisition Posting Title Coding Denials Specialist

Ventra Health, Inc.; Coimbatore District; On-site; INR 4,042,348 - 5,774,783; Full time

Job summary

Ventra Health, Inc. is seeking a Coding Denial Specialist to investigate health plan denials and drive resolutions. You will manage denial investigations, ensure coding accuracy, and generate appeals aligned with payer contracts.

You will process denial management work queues, adhere to policies, and maintain up-to-date knowledge of billing workflows and internal systems. Experience in physician billing and AAPC/AHIMA certification is required.

Qualifications

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

Responsibilities

• Process accounts meeting coding denial criteria including rejections, down codes, bundling, modifiers, and service levels.
• Resolve work queues per priority and management direction.
• Validate denial reasons and ensure coding accuracy.
• Generate appeals based on dispute reason and payor terms; including online reconsiderations.
• Follow payer guidelines for appeals submissions.
• Escalate exhausted appeal efforts for resolution.
• Adhere to production and quality standards.
• Complete special projects and maintain knowledge of workflow tools.

Skills

Health policy knowledge

coding denial management

Analytical skills

Communication skills

Independence

Education

High school diploma

AAPC/AHIMA certification

Tools

Excel

Outlook

Word

Pivot tables

Database software

Job description

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Job Summary

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

Essential Functions and Tasks

• Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned queues.
• 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.

Education and Experience Requirements

• 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.

Knowledge, Skills, and Abilities

• 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.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Equal Employment Opportunity

Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity, expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.