Coding Denials Specialist

Coding Denials Specialist

Job Title – Position Description: Coding and Coding Denials Specialist

On Site- Initially for the first 3 months, option for remote thereafter

Reports to: Coding Supervisor MISSION

We are seeking a detail-oriented and knowledgeable Medical Coder with experience in claims scrubbing and denial management to join our Revenue Cycle team. The ideal candidate will be responsible for accurate CPT/ICD-10 coding, ensuring claims are clean and compliant before submission, and investigating and resolving denials from payers. This role plays a key part in optimizing reimbursement and reducing payment delays.

OUTCOMES

• Code medical procedures and diagnoses using CPT, ICD-10, and HCPCS codes based on provider documentation.
• Review and scrub claims for accuracy, completeness, and compliance with payer policies before submission.
• Identify and correct coding errors, mismatched modifiers, or billing inconsistencies that may lead to denials.
• Analyze claim denials and rejections, determine root causes, and coordinate appeals or corrections.
• Collaborate with providers, billing staff, and payers to resolve documentation or coding discrepancies.
• Keep current with coding regulations, payer guidelines, and compliance updates (Medicare, Medicaid, commercial insurers).
• Maintain accurate records of coding decisions, appeals, and resolution timelines.
• Assist in process improvements to reduce denial rates and enhance claim acceptance.

COMPETENCIES

Job Related Competencies:

1. Action Oriented: Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
2. Manages Ambiguity: Operating efficiently, even when things are not certain, or the way forward is not clear.
3. Manages Complexity: Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
4. Decision Quality: Making good and timely decisions that keep the organizations moving forward
5. Global Perspective: Taking a broad view and approaching issues, using a global lens.
6. Resourcefulness: Securing and deploying resources effectively and efficiently.

Cultural Competencies:

Advanced Values:

1. People
   • Collaborates: Building partnerships and working collaboratively with others to meet shared objectives
2. Heart
   • Patient Focus: Building strong patient relationships and delivering patient centric solutions
3. Service
   • Instills Trust: Gaining the confidence and trust of others through honesty, integrity, and authenticity
4. Excellence
   • Cultivates Innovation: Creating new and better ways for the organization to be successful

Behaviors:

1. Being Resilient:
   • Rebounding from setback and adversity when facing difficult situations
2. Self-Development:
   • Actively seeking new ways to grow and be challenged using both formal and informal development challenges
3. Optimizes Work Processes:
   • Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement
4. Professional Communication:
   • Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences, while maintaining a professional appearance and tone

QUALIFICATIONS

Basic Qualifications:

Education:

• Certified Professional Coder (CPC) or equivalent credential (e.g., CCS, CCA, RHIT) – required.
• High School Diploma or GED

Previous Job Relevant Work Experience:

• Experience with claim scrubbing tools or clearinghouse platforms (e.g., Trizetto, Waystar, Availity, Change Healthcare).
• Working knowledge of denial codes (CARC/RARC), payer rules, and appeal processes.
• Proficient with EHR and billing systems (eClinicalWorks)
• Strong attention to detail, organizational skills, and ability to meet deadlines.
• Excellent communication and problem-solving skills.
• 2+ years of medical coding experience, preferably in urology specialty Previous experience in Urology Billing and Coding