Remote Coding Denials Specialist: Appeals & Reimbursement

Medical College of Wisconsin; Wauwatosa (WI); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

403B retirement plan

Paid time off & holidays

Tuition reimbursement

Parental leave

Employee & Family Assistance Program

Pet Insurance

On-campus fitness facility

Discounted rates for services

Job summary

Medical College of Wisconsin is seeking a Coding Denials Specialist to manage complex coding denials, appeals and related correspondence. You will analyze denials, collaborate with prior authorization, and drive process improvements in a dynamic Revenue Cycle team.

The role requires extensive coding knowledge (CPT/ICD-10), payer policies, and strong communication skills. A CCS, CPC, or CCA and/or RHIT/RHIA are preferred; a bachelor’s degree is a plus.

Qualifications

• Minimum required education: High school diploma.
• Minimum five years of experience in a health care setting, working in coding and/or reimbursement follow up.
• Certified professional coder (CCS-P, CPC, or CCA) and/or health information management credential (RHIT or RHIA).
• Preferred: Bachelor's degree in business, health care management, or related fields.
• Preferred experience: five+ years in coding/reimbursement follow up in large multispecialty or academic centers.

Responsibilities

• Research payer denials related to coding, documentation, and billing resulting in denials and delays in payment.
• Review denial details and associated notes to decide actions on revised claims or retro authorizations.
• Write and submit appeals with compelling arguments based on documentation, policies, and contracts.
• Submit detailed, customized appeals per Medicare/Medicaid and payer guidelines as well as MCW policies.
• Collaborate with prior authorization to obtain retro-authorizations per payor requirements.
• Identify denial patterns and escalate with information for root-cause resolution.
• Suggest improvements to queues/claim edits to reduce denials.
• Review payer communications and flag risk for loss reimbursement to stakeholders.
• Participate in process improvement initiatives.
• Other duties as assigned.

Skills

Payer policies

CPT ICD-10 coding

EPIC EMR

Microsoft Office

Communication skills

Multi-tasking

Teamwork & problem-solving

Education

High school diploma

Bachelor's degree in business/healthcare management or related fields

Tools

EPIC

Microsoft Office

Job description

Medical College of Wisconsin is seeking a Coding Denials Specialist to manage complex coding denials, appeals and related correspondence. You will analyze denials, collaborate with prior authorization, and drive process improvements in a dynamic Revenue Cycle team.

The role requires extensive coding knowledge (CPT/ICD-10), payer policies, and strong communication skills. A CCS, CPC, or CCA and/or RHIT/RHIA are preferred; a bachelor’s degree is a plus.