Remote Coding Denials Specialist – Appeals & Recovery

The Medical College of Wisconsin, Inc.; Wisconsin; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Excellent health coverage

403B retirement package

Paid vacation & holidays

Tuition reimbursement

Paid parental leave

EFAP (Employee & Family Assistance)

Job summary

The Coding Denials Specialist at The Medical College of Wisconsin, Inc. analyzes and resolves coding denials and claim edits. You will research payer denials and prepare compelling appeals based on clinical documentation and payer policies.

Collaborating with prior authorization teams, you will track outcomes and identify patterns to reduce denials and improve revenue cycle performance within MCW’s healthcare network.

Qualifications

• Knowledge of payer policies and claims requirements.
• Advanced knowledge of CPT and ICD-10 coding.
• Proficiency with EMR (EPIC) and Microsoft Office.
• Focus on continuous process improvement and written communications.

Responsibilities

• Research payer denials related to coding, documentation, and pre-authorization.
• Writes and submits professional appeals with clinical justification.
• Collaborate with prior authorization to obtain retro-authorizations.
• Identify denial patterns and suggest queue/workflow improvements.

Skills

Payer policies

CPT coding

ICD-10 coding

EMR (EPIC)

Microsoft Office

Communication skills

Writing capabilities

Multitasking

Interpersonal skills

Education

High school diploma

Bachelor’s degree in business, health care management, or related fields

Certified professional coder (CCS-P, CPC, or CCA)

RHIT or RHIA credential

Tools

EPIC

Microsoft Office

Job description

The Coding Denials Specialist at The Medical College of Wisconsin, Inc. analyzes and resolves coding denials and claim edits. You will research payer denials and prepare compelling appeals based on clinical documentation and payer policies.

Collaborating with prior authorization teams, you will track outcomes and identify patterns to reduce denials and improve revenue cycle performance within MCW’s healthcare network.