Denials Specialist

Responsibilities

• Review provider documentation to ensure accurate diagnosis and procedure code reporting
• Research CMS LCD, NCD, NCCI Edit Policy, CPT Assistant, HCPCS Coding Clinics, and payer guidelines
• Complete charge corrections and update claims when coding corrections are required
• Identify claims that do not support billed CPT codes and take necessary action
• Resolve claims requiring adjustments by updating billed E/M and procedure codes
• Identify denial trends and provide feedback to prevent future occurrences

Requirements

• Professional coding certification (CPC, CCS, CIC, or COC)
• 1 year of experience in a coding-related denials management role
• Strong working knowledge of CPT, HCPCS, and ICD-10-CM/PCS
• Expertise in modifiers, NCCI edits, and Medicare/commercial payer billing rules
• Experience with denial types including medical necessity, timely filing, and unbundling
• Strong analytical skills and attention to detail
• Knowledge of payer contracts and reimbursement methodologies

Preferred Qualifications

• Experience with complex surgical specialties and interventional radiology (IR)
• Familiarity with Athena