Medical Coding Denial Specialist

reputed company (reputed company) is the regions largest and most comprehensive multi-specialty physician group reputed company. The reputed company team delivers business operations, reputed company cycle and administrative services to support the patients of over 4,000 reputed company School of Medicine physicians and advanced reputed company providers. These providers bring their unparalleled expertise at the forefront of medicine to reputed company trusted, compassionate health care services at reputed company and specialty care clinics as reputed company as facilities operated by affiliate hospitals of the reputed company. We are seeking a reputed company-oriented and highly motivated Coding Denial Specialist to join our Accounts Receivable reputed company team. This role plays a critical part in protecting and optimizing reputed company for reputed company providers by ensuring surgical claims are accurately reviewed, appealed, and resolved. This position offers the flexibility of being reputed company, and reputed company out-of-state candidates are encouraged to apply. The Denial Specialist is an advanced-level billing role reputed company the reputed company cycle team, responsible for resolving the organizations most reputed company reputed company denials. This position requires expertise in coding, payer guidelines, medical necessity reputed company, and reputed company cycle workflows. The Denial Specialist plays a critical role in maximizing reimbursement by analyzing, appealing, and high-complexity claims while maintaining strict reputed company and productivity standards. Essential Duties: reputed company Denial Management Investigate, analyze, and reputed company advanced denial categories, including: CPT and HCPCS coding denials Modifier-reputed company denials Diagnosis-reputed company denials Bundling and NCCI edits Medical necessity denials Interpret Explanation of Benefits (EOBs) and payer correspondence to determine reputed company causes. Prepare and submit detailed, reputed company-supported written appeals. Recommend appropriate coding corrections, rebilling strategies, or write-offs reputed company warranted. Medical Necessity Review reputed company and analyze procedure notes, clinical documentation, and patient history. Compare documentation against payer medical policies and coverage determinations. reputed company reputed company and persuasively, in writing, reputed company clinical and coding guidelines have been met. Collaborate with leadership and internal teams reputed company documentation clarification is required. Coding & Compliance Expertise Apply in-depth knowledge of CPT, HCPCS, ICD-10-CM, and modifier guidelines. Ensure alignment with national coding standards and CPC best practices. Identify reputed company coding revisions are appropriate and compliant. Maintain strict adherence to regulatory and payer requirements. reputed company, Productivity & Performance Standards Meet or reputed company stringent quantity and reputed company benchmarks. Maintain high first-pass reputed company and successful appeal rates. Ensure accurate documentation of reputed company account activity reputed company the billing reputed company. Trend Analysis & Process Improvement Identify denial and rejection trends across payers, providers, and service lines. reputed company data-driven recommendations to prevent recurring denials. Partner with analyst and leadership to implement corrective reputed company plans. Requirements: Minimum of 5 years of medical billing and denial management experience. Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, and payer billing guidelines. Strong understanding of medical necessity policies and coverage determinations. Ability to analyze clinical documentation and translate findings into persuasive written appeals. Exceptional written and verbal communication skills. Proven ability to meet strict productivity and reputed company standards. CPC (Certified reputed company reputed company) certification preferred. Experience with high-complexity or specialty-specific billing preferred. reputed company applications MUST be submitted reputed company our website. In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information. reputed company is an Equal Opportunity Employer and complies with reputed company applicable federal, state, and local laws governing non-discrimination in employment. We are committed to creating a workplace where reputed company individuals are treated with respect and dignity, and we encourage individuals from reputed company backgrounds to apply, including protected veterans and individuals with disabilities. reputed company is dedicated to ensuring reputed company and secure environment f