Surgical Denial Specialist

University of Colorado Medicine; Aurora (CO); On-site; USD 70,000 - 90,000; Full time

Job summary

University of Colorado Medicine (CU Medicine) is seeking a Surgical Coding Denial Specialist to resolve insurance claim denials for surgical departments, with emphasis on orthopedic and surgical cases. The role requires preparing written appeals, researching payer policies, and managing high volume denial resolutions.

Candidates should have 3–5 years in medical practice billing, ICD-10/CPT coding, CPC certification, and strong contract understanding.

Qualifications

• 3-5 years experience in medical practice billing with exposure to denials, appeals, and insurance collections.

Responsibilities

• Appeal denials through coding review, contract review, medical record review and carrier interaction.
• Demonstrate expertise in managing complicated denied claims and deploy analytical approaches to resolve denials.
• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as escalation point for unresolved denial issues.
• Inform team of payer policy changes and assist in training new employees.

Skills

CPC certification

ICD-10/CPT coding

Denials appeals

Surgery experience

Education

Bachelor's degree

Tools

Microsoft Office

Job description

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado.

We are seeking a highly motivated Surgical Coding Denial Specialist to join the AR Surgery team.

This job can be performed 100% remotely and out of state candidates will be considered.

The Surgical Coding Denial Specialist is primarily responsible for resolving all insurance claim denials for assigned surgical specialty departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Utilize a multitude of resources to ensure correct appeal processes are followed. Account investigation may be quite extensive and complex. Surgical Coding Denial Specialistsare independently accountable for the denial resolution for their assigned divisions - orthopedic and surgery experience is highly preferred.

Duties and responsibilities include but are not limited to the following:

• Appeal denials through coding review, contract review, medical record review and carrier interaction.
• Demonstrate a high level of expertise in the management of complicated denied claims.
• Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
• Communicate identified denial patterns to management.
• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Assist in training new employees as assigned.
• Collaborate on special projects as needed.

Requires 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up; bachelor’s degree in a related field is strongly preferred. Must have ICD-10 and CPT coding assessment skills, CPC certification is required. Surgery experience is highly preferred. Intermediate PC software experience required. Advanced verbal and written communication skills are essential. Must demonstrate a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.

CU Medicine is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws governing non-discrimination in employment. We are committed to creating a workplace where all individuals are treated with respect and dignity, and we encourage individuals from all backgrounds to apply, including protected veterans and individuals with disabilities.

CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment.

The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data.

A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer.

CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck. Find information about our benefits here.

CU Medicine will post all jobs for a minimum of 7 days or until 250+ applicants have been received (whichever comes first).

CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.