Remote Coding Denials & Appeals Specialist

mcw; United States; On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health coverage

403B retirement

Paid time off

Tuition reimbursement

Parental leave

EFAP

Pet Insurance

On campus Fitness Facility

Discount programs

Job summary

MCW is seeking a Coding Denials Specialist to perform advanced denials management, resolving coding edits and related denials while monitoring for trends. You will write compelling appeals, obtain retro-authorizations as needed, review medical records, and ensure timely submissions in line with Medicare, Medicaid, payers' policies, and MCW's compliance standards.

Candidates should have a CCS-P/CPC/CCA or RHIT/RHIA credential and at least five years in coding or reimbursement in large health

Qualifications

• Minimum Required Education: High school diploma.
• Five (5) years of experience in a health care setting, coding and/or reimbursement follow up.
• Certified professional coder (CCS-P, CPC, or CCA) and/or RHIT or RHIA.

Responsibilities

• Research payer denials related to coding, documentation, referral, pre-authorization, and billing.
• Review denial details to determine if revised claim or appeal is needed.
• Write and submit timely appeals with supporting documents and policies.
• Submit detailed appeals to payers per Medicare/Medicaid and guidelines.
• Collaborate with the prior authorization team to obtain retro-authorizations.
• Identify denial patterns and report to management with root-cause information.
• Suggest queue and claim edits to improve efficiency and reduce denials.
• Review payer communications and escalate issues to clinical stakeholders and Revenue Cycle leadership.
• Identify opportunities for process improvement.

Skills

Payer policies & claims requirements

CPT & ICD-10 coding knowledge

EPIC EMR proficiency

Microsoft Office proficiency

Process improvement

Written communication

Multitasking

Teamwork & problem-solving

Education

High school diploma

Bachelor's degree in business or health care management

Tools

EPIC EMR

Microsoft Office

Job description

MCW is seeking a Coding Denials Specialist to perform advanced denials management, resolving coding edits and related denials while monitoring for trends. You will write compelling appeals, obtain retro-authorizations as needed, review medical records, and ensure timely submissions in line with Medicare, Medicaid, payers' policies, and MCW's compliance standards.

Candidates should have a CCS-P/CPC/CCA or RHIT/RHIA credential and at least five years in coding or reimbursement in large health