Remote Coding Denials Specialist – Reimbursement Expert

Medical College of Wisconsin; Alabama; On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health insurance

403B retirement package

Competitive vacation & holidays

Tuition reimbursement

EFAP (Employee & Family Assistance)

Job summary

Medical College of Wisconsin is seeking a Coding Denials Specialist to manage advanced level denials related to coding edits and claim denials. The role involves researching payer denials, preparing timely appeals, and collaborating with prior authorization to minimize adjustments.

The ideal candidate has deep CPT/ICD-10 knowledge, experience with EPIC, and strong written communication skills, with at least five years in healthcare coding or reimbursement follow-up.

Qualifications

• Minimum education: High school diploma.
• Minimum 5 years in a healthcare setting working in coding or reimbursement follow up.
• Certification: CCS-P, CPC, or CCA or RHIT/RHIA licensure.
• Preferred: Bachelor’s degree in business, healthcare management, or related field.

Responsibilities

• Research payer denials related to coding and documentation.
• Review denials, determine if revised claim, retro authorization or written appeal is needed.
• Write and submit professional appeals with supporting policy and contract language.
• Submit detailed appeals to payers following Medicare, Medicaid and third-party guidelines.
• Collaborate with prior authorization to obtain retro-authorizations.
• Identify denial patterns and escalate for root-cause resolution.
• Suggest improvements to work queues and claim edits to reduce denials.
• Review payer communications and flag potential issues for stakeholders.
• Identify opportunities for process improvement and participate in initiatives.
• Perform other duties as assigned.

Skills

Payer policies

CPT/ICD-10 coding

EMR knowledge (EPIC)

Microsoft Office

Written communication

Multitasking

Teamwork

Education

High school diploma

Bachelor’s degree in business/healthcare

Tools

EPIC EMR

Microsoft Office

Job description

Medical College of Wisconsin is seeking a Coding Denials Specialist to manage advanced level denials related to coding edits and claim denials. The role involves researching payer denials, preparing timely appeals, and collaborating with prior authorization to minimize adjustments.

The ideal candidate has deep CPT/ICD-10 knowledge, experience with EPIC, and strong written communication skills, with at least five years in healthcare coding or reimbursement follow-up.