Denials & Appeals Specialist — Medical Billing

Ventra Health, Inc.; United States; Remote; USD 52,000 - 68,000; Full time

Job summary

Ventra Health, Inc. is seeking a Coding Denial Specialist to investigate and resolve health plan denials, manage denial work queues, and ensure accurate coding. You will generate appeals and follow payer guidelines for timely resolution of issues.

Requirements include a high school diploma and 1–3 years in physician billing with denials; a current AAPC or AHIMA certification is preferred. This role offers a performance-based incentive plan and a fast-paced, collaborative environment.

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 preferred.

Responsibilities

• Process accounts that meet coding denial management criteria, including rejections, down codes, bundling issues, modifiers, and level of service.
• Resolve work queues according to priority and management direction, following policies and job aids.
• Validate denial reasons and ensure coding accuracy.
• Generate an appeal based on dispute reason and payor contract terms, including online reconsiderations.
• Follow payer guidelines for appeals submission and escalate exhausted appeals for resolution.
• Adhere to departmental production and quality standards.
• Complete special projects as assigned and maintain knowledge of workflow and tools.

Skills

Health insurance knowledge

Physician billing

Coding guidelines

CMS guidelines

AHA guidelines

Communication skills

Time management

Organizational skills

Independent work

Education

High school diploma or equivalent

AAPC or AHIMA certification preferred

Tools

Excel

Pivot tables

Outlook

Word

Database software

Job description

Ventra Health, Inc. is seeking a Coding Denial Specialist to investigate and resolve health plan denials, manage denial work queues, and ensure accurate coding. You will generate appeals and follow payer guidelines for timely resolution of issues.

Requirements include a high school diploma and 1–3 years in physician billing with denials; a current AAPC or AHIMA certification is preferred. This role offers a performance-based incentive plan and a fast-paced, collaborative environment.